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General NPI Number Information
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NPI Number | 1699934828
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Entity Type | Individual
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Provider Name | STEPHEN ROBERT BRODERICK MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 601 N CAROLINE ST FL 8
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City | BALTIMORE
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State | MD
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Zip | 21287-0006
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Country | US
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Telephone | 443-997-1508
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Fax | 443-769-1242
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | BALTIMORE
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-6423
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Fax | 410-500-4266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2012013459
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD043771
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2012013459
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D80914
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License Number State | MD
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