Healthcare Provider Details

I. General information

NPI: 1528640083
Provider Name (Legal Business Name): KATHRYN BRADY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS CV STE 101
NEW LONDON CT
06320-4956
US

IV. Provider business mailing address

2455 BOSTON POST RD UNIT A5
GUILFORD CT
06437-1472
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-1419
  • Fax: 860-442-2604
Mailing address:
  • Phone: 914-255-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number84520
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: