MEDICARE: JOHN P BRADY MD PC

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	207R00000X	Internal Medicine Physician	MD032377E	PA

General Provider Information

NPI Number	:	1679802748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN P BRADY MD PC

Provider Business Mailing Address
First Line	:	900 RUTTER AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4906
Country	:	US
Telephone Number	:	570-287-5588
Fax Number	:	570-287-3799

Provider Business Practice Location Address
First Line	:	900 RUTTER AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4906
Country	:	US
Telephone Number	:	570-287-5588
Fax Number	:	570-287-3799

Authorized Official
Title or Position	:	MD
Name	:	JOHN PAUL BRADY
Credential	:	MD
Telephone Number	:	570-287-5588

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	12/18/2009

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