Provider Demographics
NPI:1053358812
Name:BRADT, SUSAN DIANA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANA
Last Name:BRADT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANA
Other - Last Name:EHRSAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:207 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801
Mailing Address - Country:US
Mailing Address - Phone:828-251-2700
Mailing Address - Fax:828-251-2725
Practice Address - Street 1:207 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-251-2700
Practice Address - Fax:828-251-2725
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908173Medicaid