Basic Information
| Provider Information | |||||||||
| NPI: | 1205839321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUDGE | ||||||||
| FirstName: | BRADLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR STE 2300 | ||||||||
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| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN STANTON RD STE 3301 | ||||||||
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| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197137021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | C20023816 | DE | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.