Individual
DR. RICHARD PERRY BRADSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-4193
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
191061-1
NY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD043186L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012731650001
—
PA
05
—
01297263
—
NY
01
—
220029205
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039827
MEDICARE GROUP
PA
Enumeration date
02/12/2006
Last updated
03/04/2021
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