Provider Demographics
NPI:1316023849
Name:BRADY, JOHN PETER III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:BRADY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-287-5588
Mailing Address - Fax:570-287-3799
Practice Address - Street 1:1212 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-287-5588
Practice Address - Fax:570-287-3799
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 032377E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
117621800OtherBLACK LUNG
C29255OtherSTERLING
81228OtherBS
110016740OtherRRMC
81228OtherFIRST PRIORITY LIFE
117621800OtherBLACK LUNG
C29255OtherSTERLING