Healthcare Provider Details

I. General information

NPI: 1962152595
Provider Name (Legal Business Name): BRADY TADAO QUON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

934 GOLDENROD DR
COSTA MESA CA
92626-1716
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2000
  • Fax:
Mailing address:
  • Phone: 714-656-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0107819
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD600005965
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: