MEDICARE: DAVID BRODEUR MD PHD

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	207RH0003X	Hematology & Oncology Physician	037964	GA

General Provider Information

NPI Number	:	1629137302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRODEUR MD PHD

Provider Business Mailing Address
First Line	:	522 GRANT ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3116
Country	:	US
Telephone Number	:	404-523-3620
Fax Number	:	866-262-5831

Provider Business Practice Location Address
First Line	:	2525 CUMBERLAND PKWY SE
Second Line	:	FOURTH FLOOR - SUITE K
City	:	ATLANTA
State	:	GA
Zip	:	30339-3915
Country	:	US
Telephone Number	:	770-431-4360
Fax Number	:	770-431-4350

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	02/01/2011

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Directions to “ DAVID BRODEUR MD PHD” Practice Location

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