1386131969 NPI number — GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1386131969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386131969 NPI number — GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386131969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1643 TREASURE LK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-9044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-955-3461
Provider Business Mailing Address Fax Number:
877-663-8721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4055 E THOUSAND OAKS BLVD SUITE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-601-4839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BRADY
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
310-601-4839

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  C51588 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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