Provider Demographics
NPI:1407892722
Name:BRADY, PAUL S (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:BRADY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 W SHERMAN AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6937
Mailing Address - Country:US
Mailing Address - Phone:631-534-7246
Mailing Address - Fax:856-457-5681
Practice Address - Street 1:994 W SHERMAN AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6937
Practice Address - Country:US
Practice Address - Phone:631-534-7246
Practice Address - Fax:856-457-5681
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418635207T00000X, 2085N0700X, 2085R0202X, 2085R0204X
NJ25MA125188002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019066520001Medicaid
PA064325Medicare ID - Type Unspecified
PA0019066520001Medicaid