Individual
DR. ELISA A BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
452 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 293-7677
(614) 293-5614
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 293-7677
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35-121132
OH
207RA0002X
Adult Congenital Heart Disease Physician
Primary
35121132
OH
207RC0000X
Cardiovascular Disease Physician
35.121132
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105922
—
OH
Enumeration date
06/12/2007
Last updated
02/22/2021
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