Provider Demographics
NPI:1417018813
Name:GRADY, BRIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:GRADY
Suffix:
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 1:45 CASTRO ST STE 165
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-861-0600
Mailing Address - Fax:415-861-0606
Practice Address - Street 1:45 CASTRO STREET DAVIES SOUTH TOWER
Practice Address - Street 2:LEVEL A, SUITE 165
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:415-861-0600
Practice Address - Fax:415-861-0606
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA605230208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC939ZMedicare PIN
H19890Medicare UPIN
CAMMM00031MMedicare ID - Type Unspecified
CAGR0060000Medicaid