Provider Demographics
NPI:1609630524
Name:FLICKINGER, BRADLEY DYLAN (MT (ASCP)CM)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DYLAN
Last Name:FLICKINGER
Suffix:
Gender:M
Credentials:MT (ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W 25TH ST APT 403
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4147
Mailing Address - Country:US
Mailing Address - Phone:330-671-4896
Mailing Address - Fax:
Practice Address - Street 1:2012 W 25TH ST APT 403
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4147
Practice Address - Country:US
Practice Address - Phone:330-671-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25495604246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Single Specialty