Individual
BRADY GERONIMO CASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1275 WAMPANOAG TRL STE 3C, RIVERSIDE, RI 02915-1217
(401) 206-0304
(401) 343-6466
Mailing address
67 BAY RD, BARRINGTON, RI 02806-4751
(917) 697-2890
(401) 343-6466
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
231158
NY
2084P0804X
Child & Adolescent Psychiatry Physician
2MA08516300
NJ
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD12323
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MEDICAL LICENSE
MD12323
RI
Enumeration date
04/16/2007
Last updated
11/15/2022
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