Provider Demographics
NPI:1194820662
Name:BRADY, STEPHEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:280 MERRIMACK ST STE 311
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:155 BORTHWICK AVE
Practice Address - Street 2:SUITE 201 WEST
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-433-9575
Practice Address - Fax:603-430-4905
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156248174400000X, 207ND0900X
NH14056207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA42992OtherHARVARD
MAP00293815OtherRAILROAD MEDICARE
MAJ21202OtherBCBS MASSACHUSETTS
MAJ21202OtherBCBS MASSACHUSETTS
MAP00293815OtherRAILROAD MEDICARE