MEDICARE: SUSAN J BRODERMAN 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	207R00000X	Internal Medicine Physician	MD034641E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001435061	OTHER	PA	BLUE SHIELD
2	007302	OTHER		AETNA PPO MANAGED CARE
3	21198960001	OTHER		KEYSTONE HEALTH EAST 65
4	21198960001	OTHER		KEYSTONE LIAISON
5	2119896001	OTHER		AMERIHEALTH HMO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	110243168	OTHER		MULTIPLAN
8	2119896001	OTHER		AMERIHEALTH ADMINISTRATOR
9	0001435061	OTHER		PERSONAL CHOICE
10	21198960001	OTHER		KEYSTONE HEALTH PLAN EAST
11	470888939	OTHER		INTERCOUNTY
12	4708888939	OTHER		DEVON
13	4708888939	OTHER		FIRST HEALTH CCN
14	PHP185	OTHER		OXFORD
15	007302	OTHER		AETNA HMO
16	278863	OTHER		MAMSI
17	1046905	OTHER		KEYSTONE MERCY HEALTHPLAN
18	PC0139	OTHER		HEALTH NET

General Provider Information

NPI Number	:	1649245689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J BRODERMAN MD

Provider Business Mailing Address
First Line	:	2325 HERITAGE DRIVE SUITE 116
Second Line	:
City	:	FURLONG
State	:	PA
Zip	:	18925
Country	:	US
Telephone Number	:	215-794-2462
Fax Number	:	215-794-8496

Provider Business Practice Location Address
First Line	:	2325 HERITAGE DRIVE SUITE 116
Second Line	:
City	:	FURLONG
State	:	PA
Zip	:	18925
Country	:	US
Telephone Number	:	215-794-2462
Fax Number	:	215-794-8496

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/21/2015

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