Provider Demographics
NPI:1043282965
Name:BRADY, DON I (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:I
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3707 BRAMBLETON AVE
Mailing Address - Street 2:#2
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3658
Mailing Address - Country:US
Mailing Address - Phone:540-725-7800
Mailing Address - Fax:540-989-6752
Practice Address - Street 1:3707 BRAMBLETON AVE
Practice Address - Street 2:#2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3658
Practice Address - Country:US
Practice Address - Phone:540-725-7800
Practice Address - Fax:540-989-6752
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-046930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5623651Medicaid
VA017879C18Medicare PIN
VA080005662Medicare PIN
VAF29228Medicare UPIN