Provider Demographics
NPI:1639345390
Name:BRADY, TRICIA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:NICOLE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRICIA
Other - Middle Name:NICOLE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:806 HOPE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1884
Mailing Address - Country:US
Mailing Address - Phone:202-641-1046
Mailing Address - Fax:
Practice Address - Street 1:2165 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3819
Practice Address - Country:US
Practice Address - Phone:904-381-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101435207L00000X
DCMD035315207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology