Provider Demographics
NPI:1952390437
Name:BRADY, PATRICIA H (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 GENESEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2113
Mailing Address - Country:US
Mailing Address - Phone:858-657-8600
Mailing Address - Fax:858-657-8625
Practice Address - Street 1:9333 GENESEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2113
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8625
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53121207Q00000X
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53723Medicare UPIN
ILL60787Medicare ID - Type Unspecified