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General NPI Number Information
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NPI Number | 1679802748
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Entity Type | Organization
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Legal Business Name | JOHN P BRADY MD PC
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 900 RUTTER AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4906
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Country | US
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Telephone | 570-287-5588
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Fax | 570-287-3799
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Provider Business Mailing Address
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Address Line | 900 RUTTER AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4906
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Country | US
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Telephone | 570-287-5588
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Fax | 570-287-3799
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Authorized Official
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Title or Position | MD
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Name | JOHN PAUL BRADY
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Credential | MD
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Telephone | 570-287-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD032377E
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License Number State | PA
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