Provider Demographics
NPI:1548353543
Name:BRADLEY, CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BROOKSEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2820
Mailing Address - Country:US
Mailing Address - Phone:614-882-9338
Mailing Address - Fax:614-882-3401
Practice Address - Street 1:700 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2820
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:614-882-3401
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006424B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2140052Medicaid
OH000000224246OtherANTHEM
G98238Medicare UPIN
OH000000224246OtherANTHEM