Basic Information
| Provider Information | |||||||||
| NPI: | 1003944406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLEY | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026333555 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Practice Location | |||||||||
| Address1: | 1096 OLD CHURCHMANS RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3023514898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C7-0003472 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | C7-0003472 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RS0010X | C2-0008798 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1003944406 | 05 | DE | MEDICAID |