Provider Demographics
NPI:1134132368
Name:BRADY, MARY THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NOWELL CT
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1228
Mailing Address - Country:US
Mailing Address - Phone:603-893-3059
Mailing Address - Fax:
Practice Address - Street 1:4 NOWELL CT
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1228
Practice Address - Country:US
Practice Address - Phone:603-893-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71333207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3056341Medicaid
G08516Medicare UPIN
MA3056341Medicaid