Provider Demographics
NPI:1538384656
Name:CASE, BRADY GERONIMO (MD)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:GERONIMO
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRADY
Other - Middle Name:GERONIMO SPECHT
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:67 BAY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4751
Mailing Address - Country:US
Mailing Address - Phone:917-697-2890
Mailing Address - Fax:401-343-6466
Practice Address - Street 1:1275 WAMPANOAG TRL STE 3C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1217
Practice Address - Country:US
Practice Address - Phone:401-206-0304
Practice Address - Fax:401-343-6466
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2MA085163002084P0804X
NY2311582084P0804X
RIMD123232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMEDICAL LICENSEOtherMD12323