Healthcare Provider Details

I. General information

NPI: 1114149788
Provider Name (Legal Business Name): MATTHEW JOSEPH BRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST ROPER RADIOLOGISTS, PA
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 2363
INDIANAPOLIS IN
46206-2363
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2988
  • Fax:
Mailing address:
  • Phone: 843-724-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2005-00415
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number30580
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number30580
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: