Provider Demographics
NPI:1457391823
Name:LUTHER W BRADY MD & ASSOC
Entity type:Organization
Organization Name:LUTHER W BRADY MD & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-762-1998
Mailing Address - Street 1:PO BOX 2284
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-6284
Mailing Address - Country:US
Mailing Address - Phone:610-789-6533
Mailing Address - Fax:610-789-6683
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:M.S. #200
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-1998
Practice Address - Fax:215-762-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD004879E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007534230001Medicaid
PA0007534230001Medicaid
PA039452Medicare ID - Type Unspecified