Basic Information
Provider Information | |||||||||
NPI: | 1346458650 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CLIFFORD | ||||||||
FirstName: | BRADLEY | ||||||||
MiddleName: | THOMAS | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 168 E MARKET ST | ||||||||
Address2: | PO BOX 3542 | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443082038 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3309960347 | ||||||||
FaxNumber: | 3309960359 | ||||||||
Practice Location | |||||||||
Address1: | 161 N FORGE ST | ||||||||
Address2: | STE 198 | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443041468 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303761043 | ||||||||
FaxNumber: | 3303769951 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/18/2007 | ||||||||
LastUpdateDate: | 07/15/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35092846 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.