Individual
BRADLEY LORAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
334 MAIN ST, STE 1, DICKSON CITY, PA 18519-1620
(570) 307-1767
(570) 307-1770
Mailing address
1605 N CEDAR CREST BLVD STE 411, ALLENTOWN, PA 18104-2323
(484) 629-2282
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA003220L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA003220L
STATE LICENSE
PA
Enumeration date
07/20/2006
Last updated
05/05/2022
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