Provider Demographics
NPI:1407260821
Name:BRADY, CAROLINE LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LEIGH
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 1:1320 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8016
Mailing Address - Country:US
Mailing Address - Phone:304-793-2220
Mailing Address - Fax:
Practice Address - Street 1:14 MEDICAL PARK STE 350
Practice Address - Street 2:EMERGENCY MEDICINE DEPT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-3790
Practice Address - Fax:803-434-3946
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268240207P00000X
WV30060207P00000X
SCLL37127207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine