Individual
BRADLEY A BLACKBURN
Active
Individual
BRADLEY A BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35053437
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221054
UNISON
OH
01
—
000000302578
ANTHEM
OH
01
—
000000511513
ANTHEM
OH
01
—
0304914
BCMH
OH
05
—
0629172
—
OH
01
—
4007005
AETNA
OH
01
—
414948
WELLCARE
OH
01
—
740475
BUCKEYE
OH
01
—
P00412281
RAILROAD MEDICARE
OH
Enumeration date
08/24/2005
Last updated
01/19/2021
Update your record
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