Provider Demographics
NPI:1346305059
Name:BRADY, JANE (DPM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2285
Practice Address - Fax:781-849-2452
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2195213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001295OtherTUFTS
MA0317179Medicaid
MAY71099OtherBCBS
MA0027935OtherNHP
MA334065OtherHPHC
MA7380911-001OtherHEALTHSOURCE
MA7389011-001OtherCIGNA
MA0317179Medicaid
MA001295OtherTUFTS