MEDICARE: LUTHER W BRADY MD & ASSOC

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
1	2085R0001X	Radiation Oncology Physician	MD004879E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457391823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHER W BRADY MD & ASSOC

Provider Business Mailing Address
First Line	:	PO BOX 2284
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-6284
Country	:	US
Telephone Number	:	610-789-6533
Fax Number	:	610-789-6683

Provider Business Practice Location Address
First Line	:	230 N BROAD ST
Second Line	:	M.S. #200
City	:	PHILA
State	:	PA
Zip	:	19102-1121
Country	:	US
Telephone Number	:	215-762-1998
Fax Number	:	215-762-1155

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUTHER W BRADY
Credential	:	M.D.
Telephone Number	:	215-762-1998

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/13/2008

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