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NPI Code Detail

MEDICARE: DR. TAHMINA HAQUE BRADY M.D.

MEDICARE: DR. TAHMINA HAQUE 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
1390200000XStudent in an Organized Health Care Education/Training Program0116028644VA
2207Q00000XFamily Medicine Physician0101265635VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1207Q00000XOTHERVAFAMILY MEDICINE

General Provider Information

NPI Number : 1255714598
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAHMINA HAQUE BRADY M.D.
Provider Business Mailing Address
First Line : 922 MAIN ST APT 403
Second Line :
City : LYNCHBURG
State : VA
Zip : 24504-1626
Country : US
Telephone Number : 202-714-1174
Fax Number :
Provider Business Practice Location Address
First Line : 16890 FOREST RD
Second Line :
City : FOREST
State : VA
Zip : 24551-4059
Country : US
Telephone Number : 202-714-1174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2015
Last Update Date : 12/01/2018

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