MEDICARE: DR. RICHARD ALAN BRODIE M.D.

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	207R00000X	Internal Medicine Physician	52540	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912900473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALAN BRODIE M.D.

Provider Business Mailing Address
First Line	:	220 SOUTH ST
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-3631
Country	:	US
Telephone Number	:	617-327-5454
Fax Number	:	617-566-6586

Provider Business Practice Location Address
First Line	:	1180 BEACON ST
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3885
Country	:	US
Telephone Number	:	617-734-2433
Fax Number	:	617-566-6586

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/05/2019

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