Provider Demographics
NPI:1285749333
Name:BRADY, LYNDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:M
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 1:11365 DORSETT RD.
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:63043
Mailing Address - Country:US
Mailing Address - Phone:314-872-6400
Mailing Address - Fax:314-872-6500
Practice Address - Street 1:11365 DORSETT RD.
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:63043
Practice Address - Country:US
Practice Address - Phone:314-872-6400
Practice Address - Fax:314-872-6500
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208824904Medicaid