Provider Demographics
NPI:1386131969
Name:GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:GAIL C. BRADY, MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-601-4839
Mailing Address - Street 1:1643 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9044
Mailing Address - Country:US
Mailing Address - Phone:800-955-3461
Mailing Address - Fax:877-663-8721
Practice Address - Street 1:4055 E THOUSAND OAKS BLVD SUITE 215
Practice Address - Street 2:
Practice Address - City:WEST LAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:301-601-4839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC515882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty