Provider Demographics
NPI:1205043304
Name:DEBRADY, AKILI MD PC
Entity type:Organization
Organization Name:DEBRADY, AKILI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKILI
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEBRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-248-6090
Mailing Address - Street 1:7601 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1608
Mailing Address - Country:US
Mailing Address - Phone:215-248-6090
Mailing Address - Fax:215-248-6091
Practice Address - Street 1:7601 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1608
Practice Address - Country:US
Practice Address - Phone:215-248-6090
Practice Address - Fax:215-248-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty