Healthcare Provider Details

I. General information

NPI: 1538384656
Provider Name (Legal Business Name): BRADY GERONIMO CASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRADY GERONIMO SPECHT CASE

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 WAMPANOAG TRL STE 3C
RIVERSIDE RI
02915-1217
US

IV. Provider business mailing address

67 BAY RD
BARRINGTON RI
02806-4751
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-0304
  • Fax: 401-343-6466
Mailing address:
  • Phone: 917-697-2890
  • Fax: 401-343-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2MA08516300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number231158
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD12323
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: