Healthcare Provider Details

I. General information

NPI: 1235824822
Provider Name (Legal Business Name): KATHRYN MARGARET BRODERICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CONNECTICUT AVE STE 220
CHEVY CHASE MD
20815-5829
US

IV. Provider business mailing address

8401 CONNECTICUT AVE STE 220
CHEVY CHASE MD
20815-5829
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-8800
  • Fax: 301-652-4933
Mailing address:
  • Phone: 301-304-8800
  • Fax: 301-652-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0107775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: