MEDICARE: JEFFREY ALAN BRODSKY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	4336	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110020548	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000136131	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1003990029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALAN BRODSKY D.O.

Provider Business Mailing Address
First Line	:	2131 LAKE AVE STE 1
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3466
Country	:	US
Telephone Number	:	440-997-6646
Fax Number	:	440-992-4238

Provider Business Practice Location Address
First Line	:	2131 LAKE AVE
Second Line	:	SUITE #1
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3466
Country	:	US
Telephone Number	:	440-997-6646
Fax Number	:	440-992-4238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/24/2008

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Directions to “ JEFFREY ALAN BRODSKY D.O.” Practice Location

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