Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 48584 | MA |
NPI | 1003898743 |
---|---|
Provider Name | Dr. Thomas Joseph Brady |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048584 | TUFTS HEALTH PLAN (01) | MA |
2084945 | (05) | MA |
B87209 | (02) | |
E05677 | BCBS MA (01) | MA |