Healthcare Provider Details

I. General information

NPI: 1235278458
Provider Name (Legal Business Name): JAMES F BRODEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE SUITE 345
FARMINGTON CT
06032
US

IV. Provider business mailing address

270 FARMINGTON AVE SUITE 345
FARMINGTON CT
06032
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-0665
  • Fax: 860-677-5412
Mailing address:
  • Phone: 860-674-0665
  • Fax: 860-677-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCT013059
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberCT013059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: