BRADLEY WILLIAM PETKOVICH (NPI# 1033485156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1033485156 |
Entity Type | Individual |
Full Name | BRADLEY WILLIAM PETKOVICH |
Credential | M.D. |
Practice Address |
171 Ashley Avenue Charleston SC 29425-0001 |
Mailing Address |
Po Box 751461 Charlotte NC 28275-1461 |
Practice Telephone | 8437921414 |
Mailing Telephone | 8437926200 |
Enumeration Date | 2012-03-23 |
Last Update Date | 2019-08-01 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
39692 | SC | Allopathic & Osteopathic Physicians |
N | 390200000X | Student in an Organized Health Care Education/Training Program | AR | Student, Health Care |
Street Address |
171 ASHLEY AVENUE |
City | CHARLESTON |
State | SC |
Zip Code | 29425-0001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225037765 | Rachel L. Sturdivant | Internal Medicine | 171 Ashley Avenue, Charleston, SC 29425-0100 | 2005-07-18 |
1881238111 | Lindsey Dill Willis | Nurse Practitioner | 171 Ashley Avenue, Charleston, SC 29425 | 2019-10-30 |
1760025258 | Chad Michael Davis | Nurse Practitioner | 171 Ashley Avenue, Charleston, SC 29425-8908 | 2019-10-28 |
1477005700 | Hannah Secunda | Nurse Anesthetist, Certified Registered | 171 Ashley Avenue, Charleston, SC 29412-8909 | 2016-11-03 |
1720408461 | Peter O'connor | Radiology | 171 Ashley Avenue, Charleston, SC 29425-4756 | 2014-04-21 |
1306280474 | Jennifer Battaglia Waterhouse | Nurse Practitioner | 171 Ashley Avenue, Charleston, SC 29425 | 2013-04-19 |
1972801470 | Cheryl L Solesbee | Social Worker | 171 Ashley Avenue, Charleston, SC 29425-0100 | 2011-03-08 |
1700024593 | Sung Wook Choi | Anesthesiology | 171 Ashley Avenue, Charleston, SC 29425 | 2009-02-02 |
1578759502 | Evgenia Kagan | Internal Medicine | 171 Ashley Avenue, Charleston, SC 29425-0001 | 2007-09-24 |
1356532311 | Katherine Elizabeth Twombley | Pediatrics | 171 Ashley Avenue, Charleston, SC 29425-8908 | 2007-08-06 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922607217 | Krishna Bhandari | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10 Mcclennan Banks Drive, 2190-r, Msc 918, Charleston, SC 29425 | 2020-10-19 |
1649892456 | Mary Macrae Lynch | Social Worker | 179 Ashley Avenue, Charleston, SC 29425 | 2020-05-14 |
1528600053 | Amanda Watts | Physician Assistant | 135 Rutledge Ave. Msc 561, Charleston, SC 29425 | 2019-10-16 |
1851945497 | Kacy Wonder | Dentist | 173 Ashley Avenue Room 453 Msc 507, Charleston, SC 29425 | 2019-08-01 |
1477114569 | Justin Robert Silverman | Surgery | 169 Ashley Avenue, Room 202 Muh, Msc 333, Charleston, SC 29425 | 2019-06-28 |
1740840024 | Tyler Buckley | Surgery | 169 Ashley Ave, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2019-06-18 |
1366001760 | Rayphael Sebastian Hardy | Internal Medicine | 169 Ashley Avenue Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2019-06-10 |
1437718889 | Samar Medani | Internal Medicine | Division of Nephrology, Medical Univ of South Carolina, 96 Jonathan Lucas Street, Room 822, Msc 629, Charleston, SC 29425 | 2019-06-10 |
1427617950 | Emily Suzanne Nyers | Internal Medicine | 169 Ashley Ave., Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2019-06-09 |
1790343564 | Alan Cowei Peh | Psychiatry & Neurology | 169 Ashley Avenue Rm 202, Main Hospital Msc 333, Charleston, SC 29425 | 2019-06-05 |
Find all providers in zip 29425 |
Taxonomy Code | 207RP1001X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Pulmonary Disease |
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982756094 | Mallinath Kayi | Internal Medicine | 401 Division St Ste 305, Charleston, WV 25309-1455 | 2007-01-17 |
1699786939 | Sleepmed Inc. | Internal Medicine | 1867 Savage Rd, Charleston, SC 29407 | 2006-08-11 |
1144256819 | Robert E Hillberg | Internal Medicine | 300 First Ave., Charleston, MA 02129-1101 | 2006-06-24 |
1063465250 | Coastal Pulmonary, LLP | Internal Medicine | 63 Gadsden St, Charleston, SC 29401-1211 | 2006-05-18 |
1457322059 | Daniel Kassaye Game | Internal Medicine | 1866 Raoul Wallenberg Blvd, Suite B, Charleston, SC 29407-3545 | 2006-01-31 |
1629061973 | Lo'ay M. Al-asadi | Internal Medicine | 2335 Chesterfield Ave Ste 103, Charleston, WV 25304 | 2005-08-23 |
1053312314 | Kurt M. Nellhaus, M.d. | Internal Medicine | 3100 Maccorkle Ave Se, Suite 806, Charleston, WV 25304-1223 | 2005-08-09 |
1255738308 | Roper Saint Francis Physicians Network | Internal Medicine | 2095 Henry Tecklenburg Dr, Charleston, SC 29414 | 2014-12-04 |
1386930105 | Mario Carlos Ponce Alvarez | Internal Medicine | 96 Jonathan Lucas St, Csb Suite 812, Msc 630, Charleston, SC 29425-8900 | 2011-06-20 |
1003047168 | Roper Saint Francis Physicians Network | Internal Medicine | 2095 Henry Tecklenburg Dr, Charleston, SC 29414-5733 | 2009-08-06 |
Find all providers in CHARLESTON |
City | CHARLESTON |
Zip Code | 29425 |
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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.