Healthcare Provider Details

I. General information

NPI: 1609300649
Provider Name (Legal Business Name): MERRICK ADAM BRODSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 300
LONG BEACH CA
90808-1793
US

IV. Provider business mailing address

12700 PARK CENTRAL DR STE 1210
DALLAS TX
75251-1522
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-1144
  • Fax: 562-997-9881
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA178273
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number61263332
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number61263332
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number61263332
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: