MEDICARE: DR. RONDA LYNN BROADY 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	207Q00000X	Family Medicine Physician	102202230	VA
2	207Q00000X	Family Medicine Physician	C20006590	DE
3	207Q00000X	Family Medicine Physician	OS011005L	PA

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

General Provider Information

NPI Number	:	1558381012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONDA LYNN BROADY D.O.

Provider Business Mailing Address
First Line	:	1055 ANDREW DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3446
Country	:	US
Telephone Number	:	610-431-0865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 ANDREW DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3446
Country	:	US
Telephone Number	:	610-431-0865
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/19/2015

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