Basic Information
| Provider Information | |||||||||
| NPI: | 1861493132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT STREET | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
| FaxNumber: | 4137941629 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WASON AVENUE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945265 | ||||||||
| FaxNumber: | 4137941794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 270355 | MA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0003031 001 | 01 | CT | CIGNA | OTHER | 061200871 | 01 | CT | GREAT WEST HEALTHCARE | OTHER | 782084 | 01 | CT | AETNA | OTHER | 001261296 | 05 | CT | MEDICAID | 10790 | 01 | CT | HEALTH NEW ENGLAND | OTHER | 06-1406459 | 01 | CT | COLONIAL COOPERATIVE CARE | OTHER | 061200871 | 01 | CT | NORTHEAST HEALTH DIRECT CHN PPO | OTHER | 061200871 | 01 | CT | MULTIPLAN PHCS | OTHER | 0S2066 | 01 | CT | HEALTH NET | OTHER | 010026129CT03 | 01 | CT | ANTHEM BCBS | OTHER | 026129-0403 | 01 | CT | CONNECTICARE | OTHER | 061200871 | 01 | CT | UNITED HEALTHCARE | OTHER | 061200871 | 01 | CT | CORVEL | OTHER | 06-1406459 | 01 | CT | PIONEER | OTHER | 061200871 | 01 | CT | COVENTRY/FIRST HEALTH | OTHER | 3163547 | 01 | MA | MASSHEALTH | OTHER | P825539 | 01 | CT | OXFORD | OTHER |