Basic Information
| Provider Information | |||||||||
| NPI: | 1285673582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KEEFER DR | ||||||||
| Address2: | |||||||||
| City: | MERCERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172361732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173282119 | ||||||||
| FaxNumber: | 7173280071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD069405L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1285673582 | 01 | PA | HEALTH AMERICA | OTHER | 001799285002 | 05 | PA | MEDICAID | 1568815 | 01 | PA | GATEWAY GROUP | OTHER | 23-1401561 | 01 | PA | INTERGROUP | OTHER | 50093786 | 01 | PA | CAPITAL BLUECROSS | OTHER | P00841811 | 01 | PA | RAILROAD MEDICARE | OTHER | V007-0006 | 01 | DC | CAREFIRST DC | OTHER | 001799285 0006 | 05 | PA | MEDICAID | 23-1401561 | 01 | PA | INFORMED | OTHER | 23-1401561 | 01 | PA | MULTIPLAN/PHCS | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 10923537 | 01 | CAQH | OTHER | 23-1401561 | 01 | PA | GREATWEST HEALTHCARE | OTHER | 305587 | 01 | PA | UNISON | OTHER | 6367958 | 01 | PA | AETNA HMO | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 901151-02 | 01 | MD | CAREFIRST MD | OTHER | V007/D0MZMO | 01 | CAREFIRST GROUP | OTHER | 23-1401561 | 01 | PA | HEALTHNET/TRICARE | OTHER | 7453150 | 01 | PA | AETNA NON-HMO | OTHER | BB6631407 | 01 | DEA REGISTRATION | OTHER | 120420417 | 01 | PA | DEPT OF LABOR | OTHER | 23-1401561 | 01 | PA | FIRST HEALTH | OTHER | 23-1401561 | 01 | PA | DEVON | OTHER | BR181837 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | MD069405L | 01 | PA | PHYSICIAN LICENSE | OTHER | 23-1401561 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | P010548 | 01 | PA | GATEWAY | OTHER |