Provider Demographics
NPI:1932561172
Name:BRADY, MICHAEL UNDERWOOD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:UNDERWOOD
Last Name:BRADY
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 1:1704 EUTAW PL APT 2R
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3742
Mailing Address - Country:US
Mailing Address - Phone:919-475-3521
Mailing Address - Fax:
Practice Address - Street 1:4120 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2254
Practice Address - Country:US
Practice Address - Phone:410-764-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0084492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine