MEDICARE: JOSEPH BRODERICK 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
1	2084V0102X	Vascular Neurology Physician	35 055278	OH
2	2084N0400X	Neurology Physician	35 055278	OH

General Provider Information

NPI Number	:	1609817642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BRODERICK MD

Provider Business Mailing Address
First Line	:	3113 BELLEVUE AVE FL 3
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3158
Country	:	US
Telephone Number	:	513-475-8730
Fax Number	:	513-475-8033

Provider Business Practice Location Address
First Line	:	3113 BELLEVUE AVE FL 3
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3158
Country	:	US
Telephone Number	:	513-475-8730
Fax Number	:	513-475-8033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/05/2021

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Directions to “ JOSEPH BRODERICK MD” Practice Location

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