Provider Demographics
NPI:1639229313
Name:BRADY, JENNIFER ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6480
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-897-0822
Practice Address - Fax:410-897-0095
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035326207RC0001X
MDD0065204207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013680801Medicaid
I45239Medicare UPIN
132319Y5ZMedicare PIN