BRADLEY WALTON CLARK (NPI# 1639431307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639431307 |
| Entity Type | Individual |
| Full Name | BRADLEY WALTON CLARK |
| Credential | MD |
| Practice Address |
186 Kimel Park Dr Winston Salem NC 27103 |
| Mailing Address |
Po Box 751803 Charlotte NC 28275-1803 |
| Practice Telephone | 3362772000 |
| Practice Fax Number | 3362772050 |
| Mailing Telephone | 3362772000 |
| Mailing Fax Number | 3362772050 |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 2015-00428 | NC | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | LL34733 | SC | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
2015-00428 | NC | Allopathic & Osteopathic Physicians |
| Y | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
2015-00428 | NC | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395331 | Bradley Layton Clark | Technician | 8620 Sewell Creek Rd, Meadow Bridge, WV 25976-7674 | 2020-10-26 |
| 1124354964 | Bradley Clark | Emergency Medicine | 423 E Elaine Cir, Inkom, ID 83245-1716 | 2009-10-29 |
| 1114052966 | Bradley J Clark | Dentist | 310 S 9th Ave, Broken Bow, NE 68822-2014 | 2007-02-22 |
| 1144683863 | Bradley Layton Clark | Student in an Organized Health Care Education/Training Program | 1500 S Main St, Fort Worth, TX 76104-4917 | 2016-03-31 |
| 1407252679 | Bradley Clark | Dentist | 450 Sutter St, Suite 2109, San Francisco, CA 94108-4206 | 2014-11-14 |
| 1649532466 | Bradley J Clark | Pediatrics | 3485 W 5200 S, Roy, UT 84067-9438 | 2012-06-08 |
| 1447510722 | Bradley A Clark | Internal Medicine | 10590 N Meridian St, Indianapolis, IN 46290 | 2012-05-21 |
| 1427383124 | Bradley W Clark | Counselor | 9333 E 21st St N, Wichita, KS 67206-2927 | 2009-10-14 |
| 1316107642 | Bradley C Clark | Pediatrics | 3415 Bainbridge Ave, Bronx, NY 10467-2403 | 2008-06-10 |
| Street Address |
186 KIMEL PARK DR |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871587923 | Kenneth E Bodek | Internal Medicine | 186 Kimel Park Dr, Suite 400, Winston Salem, NC 27103-6946 | 2005-09-06 |
| 1851940753 | Casey Leigh Hardy | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2019-09-04 |
| 1881248029 | Ennie Austin | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2019-07-26 |
| 1972023737 | Francis Wingate Hayes Iv | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2017-06-22 |
| 1255786273 | Nathan Mcgeathy | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2016-04-27 |
| 1376925214 | Joseph Mintz | Physician Assistant | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2015-06-27 |
| 1679961353 | Michelle Swaim | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2015-01-02 |
| 1508107707 | Jennifer Doby Davis | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2013-03-13 |
| 1255682415 | Dawn Marie Delo O'reilly | Physician Assistant | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-09-27 |
| 1285994426 | Pallavi Sharma Gomadam | Internal Medicine | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 207UN0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Nuclear Medicine |
| Specialization | Nuclear Cardiology |
| A nuclear medicine physician who specializes in nuclear cardiology. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Nuclear Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477006385 | Charles A. Cannon, Jr. Memorial Hospital, Inc. | Nuclear Medicine | 434 Hospital Drive, Linville, NC 28646-0787 | 2016-07-27 |
| 1639236342 | Cardiac Wellness Imaging, Pllc | Nuclear Medicine | 310 S Mccaskey Rd, Williamston, NC 27892-2150 | 2007-01-02 |
| 1235227091 | Joseph Caravalho Jr. | Nuclear Medicine | 2817 Reilly Road, Womack Army Medical Center Mcxc Cod Credentials, Fort Bragg, NC 28310 | 2006-10-10 |
| City | WINSTON SALEM |
| Zip Code | 27103 |
Please comment or provide details below to improve the information on BRADLEY WALTON CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.