Individual
BRADLEY GLENN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 PARK ST, GLENS FALLS HOSPITAL, GLENS FALLS, NY 12801-4413
(518) 926-5918
(518) 926-5917
Mailing address
100 PARK STREET, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-5924
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004333
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01893645
—
NY
01
—
P00180979
RR MEDICARE
NY
Enumeration date
11/07/2005
Last updated
06/17/2021
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