MEDICARE: DAVID S BRODY, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1962654335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S BRODY, MD

Provider Business Mailing Address
First Line	:	1290 HOSPITAL DR
Second Line	:	SUITE 2
City	:	ST JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-2123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 HOSPITAL DR
Second Line	:	SUITE 2
City	:	ST JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-2123
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID BRODY
Credential	:	M.D.
Telephone Number	:	802-748-2123

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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Directions to “DAVID S BRODY, MD ” Practice Location

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