MEDICARE: GEORGE S BRODERICK D.O. INC.

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	2084P0800X	Psychiatry Physician	34007182B	OH
2	2084P0804X	Child & Adolescent Psychiatry Physician	34007182B	OH

General Provider Information

NPI Number	:	1518011998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE S BRODERICK D.O. INC.

Provider Business Mailing Address
First Line	:	4030 MOUNT CARMEL TOBASCO RD
Second Line	:	SUITE 314
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3400
Country	:	US
Telephone Number	:	513-528-9200
Fax Number	:	513-528-9202

Provider Business Practice Location Address
First Line	:	4030 MOUNT CARMEL TOBASCO RD
Second Line	:	SUITE 314
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3400
Country	:	US
Telephone Number	:	513-528-9200
Fax Number	:	513-528-9202

Authorized Official
Title or Position	:	SECRETARY TREASURER
Name	:	MRS. NEVA L BRODERICK
Credential	:
Telephone Number	:	513-553-0414

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/11/2025

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