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NPI Code Detail

MEDICARE: DR. LYNNE BRODSKY MD

MEDICARE: DR. LYNNE BRODSKY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician54629MA
2207RG0300XGeriatric Medicine (Internal Medicine) Physician54629MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2054629OTHERMATUFTS HEALTH PLAN
3J07575OTHERMABCBS MA

General Provider Information

NPI Number : 1588655419
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNNE BRODSKY MD
Provider Business Mailing Address
First Line : PO BOX 9142
Second Line : MASS GENERAL PHYSICIAN ORGANIZATION
City : CHARLESTOWN
State : MA
Zip : 02129-9142
Country : US
Telephone Number : 617-889-8580
Fax Number : 617-889-8579
Provider Business Practice Location Address
First Line : 151 EVERETT AVE
Second Line : CHELSEA HEALTHCARE CENTER
City : CHELSEA
State : MA
Zip : 02150-1807
Country : US
Telephone Number : 617-889-8580
Fax Number : 617-889-8579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 02/12/2014

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