MEDICARE: JAMES DAVID BRODELL M.D.

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	207X00000X	Orthopaedic Surgery Physician	35048150B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34144929700	OTHER	OH	BUREAU OF WORKERS' COMP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861494817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DAVID BRODELL M.D.

Provider Business Mailing Address
First Line	:	2614 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6204
Country	:	US
Telephone Number	:	330-394-8181
Fax Number	:	330-393-4849

Provider Business Practice Location Address
First Line	:	2614 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6204
Country	:	US
Telephone Number	:	330-394-8181
Fax Number	:	330-393-4849

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	03/30/2022

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