Provider Demographics
NPI:1801888474
Name:BRADY, JOHN WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8650 SUDLEY ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4416
Mailing Address - Country:US
Mailing Address - Phone:703-369-3376
Mailing Address - Fax:703-369-1118
Practice Address - Street 1:8650 SUDLEY ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4416
Practice Address - Country:US
Practice Address - Phone:703-369-3376
Practice Address - Fax:703-369-1118
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101019666207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101019666OtherMEDICAL LICENSE NUMBER
00X776J01OtherPTAN
00X776J01OtherPTAN
00X776J01OtherPTAN