NPI Code Detail JSON Logo

1699934828 NPI number — STEPHEN ROBERT BRODERICK MD

NPI Number: 1699934828
Health Care Provider/Practitioner: STEPHEN ROBERT BRODERICK MD

Information about “1699934828” NPI (STEPHEN ROBERT BRODERICK MD) exists in 1699934828 in HTML format HTML  |  1699934828 in plain Text format TXT  |  1699934828 in PDF (Portable Document Format) PDF  |  1699934828 in an XML format XML  formats.

NPI Number : 1699934828 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699934828",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRODERICK",
    "FirstName": "STEPHEN",
    "MiddleName": "ROBERT",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6201 GREENLEIGH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21220-2004",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-933-6423",
    "MailingAddressFaxNumber": "410-500-4266",
    "FirstLinePracticeLocationAddress": "601 N CAROLINE ST FL 8",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21287-0006",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "443-997-1508",
    "PracticeLocationAddressFaxNumber": "443-769-1242",
    "EnumerationDate": "06/03/2008",
    "LastUpdateDate": "04/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "2012013459",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208G00000X",
          "TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
          "LicenseNumber": "MD043771",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208G00000X",
          "TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
          "LicenseNumber": "2012013459",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208G00000X",
          "TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
          "LicenseNumber": "D80914",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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