Provider Demographics
NPI:1710357421
Name:BATES, BRAD (VMD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 W THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4421
Mailing Address - Country:US
Mailing Address - Phone:570-704-8491
Mailing Address - Fax:
Practice Address - Street 1:3139 W THOMPSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4421
Practice Address - Country:US
Practice Address - Phone:570-704-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABV012482174M00000X
NJ29VI00668200174M00000X
DEN1-0002713174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian