Healthcare Provider Details

I. General information

NPI: 1073133708
Provider Name (Legal Business Name): NICHOLAS BRADY MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CROSSINGS BLVD
WARWICK RI
02886-2878
US

IV. Provider business mailing address

200 CROSSINGS BLVD STE 310
WARWICK RI
02886-2872
US

V. Phone/Fax

Practice location:
  • Phone: 401-777-7000
  • Fax:
Mailing address:
  • Phone: 401-777-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD20620
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: