Healthcare Provider Details

I. General information

NPI: 1619574159
Provider Name (Legal Business Name): BRADY HUTTINGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

IV. Provider business mailing address

PO BOX 69709
BALTIMORE MD
21264-9709
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-4154
  • Fax: 410-749-9583
Mailing address:
  • Phone: 410-749-4154
  • Fax: 410-749-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: