Provider Demographics
NPI:1407948110
Name:BRODY, MICHAEL JAY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KILDAIRE PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8144
Mailing Address - Country:US
Mailing Address - Phone:919-816-4948
Mailing Address - Fax:919-233-7685
Practice Address - Street 1:115 KILDAIRE PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-816-4948
Practice Address - Fax:919-233-7685
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911680Medicaid
G94072Medicare UPIN
2275213AMedicare ID - Type Unspecified
NC2275213AMedicare PIN