Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0102202775 | VA |
Y | 213ES0000X | Sports Medicine | 0102202775 | VA |
N | 2081S0010X | Sports Medicine | 2557 | WV |
N | 213ES0000X | Sports Medicine | 2557 | WV |
NPI | 1417123118 |
---|---|
Provider Name | Dr. Bradley Michael Mccrady |
First Address | Christiansburg, VA 24073-6345 |
Second Address | Christiansburg, VA 24073-6345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 28/09/2021 |