Healthcare Provider Details

I. General information

NPI: 1467987446
Provider Name (Legal Business Name): JOSEPH BLISS BRODINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FRANKLIN SQUARE DR STE 300
BALTIMORE MD
21237-3966
US

IV. Provider business mailing address

9101 FRANKLIN SQUARE DR STE 300
BALTIMORE MD
21237-3966
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax: 443-777-2034
Mailing address:
  • Phone: 443-777-2000
  • Fax: 443-777-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD91600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: