Provider Demographics
NPI:1548257546
Name:BRADY, JOHN GREG (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREG
Last Name:BRADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 HAUSMAN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9108
Mailing Address - Country:US
Mailing Address - Phone:610-432-0200
Mailing Address - Fax:610-432-0202
Practice Address - Street 1:798 HAUSMAN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9108
Practice Address - Country:US
Practice Address - Phone:610-432-0200
Practice Address - Fax:610-432-0202
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004677L207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA735359OtherHIGHMARK BS
PA50094289OtherCAPITAL BC
PA735359OtherHIGHMARK BS
PAE19654Medicare UPIN