Individual
MR. BRADLEY P HEROLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 735-7421
Mailing address
67 MAPLE AVE, DERBY, CT 06418-1328
(203) 732-1330
(203) 732-1332
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3050
CT
Other
Enumeration date
02/23/2011
Last updated
10/12/2018
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