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NPI Code Detail

MEDICARE: RICHARD E. BRODER-OLDACH DO

MEDICARE: RICHARD E. BRODER-OLDACH DO
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
1207Q00000XFamily Medicine Physician34006887OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080076704OTHEROHRAILROAD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689679326
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD E. BRODER-OLDACH DO
Provider Business Mailing Address
First Line : 424 WARDS CORNER RD STE 200
Second Line :
City : LOVELAND
State : OH
Zip : 45140-6966
Country : US
Telephone Number : 513-707-4041
Fax Number : 513-576-1020
Provider Business Practice Location Address
First Line : 150 HEALTH PARTNER CIRCLE
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-9422
Country : US
Telephone Number : 937-444-2514
Fax Number : 937-444-4818
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2005
Last Update Date : 09/10/2020

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