MEDICARE: SAMUEL B BROADDUS MD

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	208800000X	Urology Physician	MD11648	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326094335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL B BROADDUS MD

Provider Business Mailing Address
First Line	:	81 MEDICAL CENTER DR
Second Line	:	SUITE 2350
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2764
Country	:	US
Telephone Number	:	207-373-6690
Fax Number	:	207-373-6695

Provider Business Practice Location Address
First Line	:	81 MEDICAL CENTER DR
Second Line	:	SUITE 2350
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2764
Country	:	US
Telephone Number	:	207-373-6690
Fax Number	:	207-373-6695

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/21/2015

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Directions to “ SAMUEL B BROADDUS MD” Practice Location

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