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NPI Code Detail

MEDICARE: JOSEPH BRODERICK MD

MEDICARE: JOSEPH BRODERICK 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
12084V0102XVascular Neurology Physician35 055278OH
22084N0400XNeurology Physician35 055278OH

General Provider Information

NPI Number : 1609817642
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH BRODERICK MD
Provider Business Mailing Address
First Line : 3113 BELLEVUE AVE FL 3
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-3158
Country : US
Telephone Number : 513-475-8730
Fax Number : 513-475-8033
Provider Business Practice Location Address
First Line : 3113 BELLEVUE AVE FL 3
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-3158
Country : US
Telephone Number : 513-475-8730
Fax Number : 513-475-8033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 04/05/2021

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Directions to “ JOSEPH BRODERICK MD” Practice Location

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