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General NPI Number Information
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NPI Number | 1386131969
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Entity Type | Organization
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Legal Business Name | GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 4055 E THOUSAND OAKS BLVD SUITE 215
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City | WEST LAKE VILLAGE
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State | CA
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Zip | 91362
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Country | US
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Telephone | 301-601-4839
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 TREASURE LK
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City | DU BOIS
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State | PA
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Zip | 15801-9044
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Country | US
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Telephone | 800-955-3461
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Fax | 877-663-8721
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GAIL C BRADY
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Credential | MD
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Telephone | 310-601-4839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C51588
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License Number State | CA
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