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NPI Code Detail

MEDICARE: ROBERT LEE BRADY M.D.

MEDICARE: ROBERT LEE BRADY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0117XOrthopaedic Surgery of the Spine Physician043646CT
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician043646CT
3207X00000XOrthopaedic Surgery Physician043646CT

General Provider Information

NPI Number : 1144229840
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LEE BRADY M.D.
Provider Business Mailing Address
First Line : 761 MAIN AVE
Second Line : SUITE 115
City : NORWALK
State : CT
Zip : 06851-1080
Country : US
Telephone Number : 203-845-2200
Fax Number : 203-847-1940
Provider Business Practice Location Address
First Line : 761 MAIN AVE STE 115
Second Line :
City : NORWALK
State : CT
Zip : 06851-1080
Country : US
Telephone Number : 203-845-2200
Fax Number : 203-845-2200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 01/16/2018

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