Basic Information
| Provider Information | |||||||||
| NPI: | 1558486688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBOTTOM | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 SUNDAY DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197823456 | ||||||||
| FaxNumber: | 9197831441 | ||||||||
| Practice Location | |||||||||
| Address1: | 4111 BEN FRANKLIN BLVD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197198834 | ||||||||
| FaxNumber: | 9195820528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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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 | 2084N0400X | D68380 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 2011-00566 | 01 | NC | NC LICENSE | OTHER | D68380 | 01 | MD | MEDICAL LICENSE | OTHER |