Basic Information
Provider Information
NPI: 1003002643
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRADT
FirstName: CARIE
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: RPA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 ELMWOOD AVE
Address2: BOX 665
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852756070
FaxNumber: 5857564727
Practice Location
Address1: 601 ELMWOOD AVE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852756070
FaxNumber: 5857564727
Other Information
ProviderEnumerationDate: 09/18/2007
LastUpdateDate: 11/30/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X012048NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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