Individual
BRADFORD THOMAS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
885 S SAWBURG RD, SUITE 105, ALLIANCE, OH 44601-5905
(330) 823-1112
(330) 823-1139
Mailing address
2777 CARRINGTON ST NW, NORTH CANTON, OH 44720-8163
(330) 244-0515
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
58282
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0738536
—
OH
01
—
340012867
MEDICARE RAILROAD
OH
Enumeration date
12/14/2005
Last updated
05/12/2008
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