Provider Demographics
NPI:1851375869
Name:MCKAIG, BRADY PIERSOL (MD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:PIERSOL
Last Name:MCKAIG
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:PO BOX 129
Mailing Address - Street 2:ATTN PATHWAYS
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0129
Mailing Address - Country:US
Mailing Address - Phone:301-373-3065
Mailing Address - Fax:301-373-6143
Practice Address - Street 1:44101 AIRPORT VIEW DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3145
Practice Address - Country:US
Practice Address - Phone:301-373-3065
Practice Address - Fax:301-373-6143
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00146812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70424Medicare UPIN
273RMedicare ID - Type Unspecified