Provider Demographics
NPI:1154399178
Name:BRADY, KAREN MARY (DO)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARY
Last Name:BRADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KOLODZIEJCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 GRAMPIAN BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1978
Practice Address - Country:US
Practice Address - Phone:570-320-7880
Practice Address - Fax:570-320-7882
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005273L207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013935100006Medicaid
PA819775OtherFIRST PRIORITY HEALTH
PA2672912OtherUNITEDHEALTHCARE
PA0013935100005Medicaid
PA191347OtherHIGHMARK BLUE SHIELD
PAF42891OtherHEALTHAMERICA
PA50055619OtherCAPITAL BLUE CROSS
PA5301057OtherAETNA
F42891Medicare UPIN
PAP00295660Medicare PIN
PA2672912OtherUNITEDHEALTHCARE