ISABEL MARGUERITE BRODERSEN (NPI# 1144247966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144247966 |
| Entity Type | Individual |
| Full Name | ISABEL MARGUERITE BRODERSEN |
| Credential | PA |
| Practice Address |
56 Franklin St Waterbury CT 06706-1221 |
| Mailing Address |
56 Franklin St 3rd Floor Waterbury CT 06706-1221 |
| Practice Telephone | 2037093538 |
| Practice Fax Number | 2037097258 |
| Mailing Telephone | 2037098873 |
| Mailing Fax Number | 2037098689 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-09-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
000155 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
56 FRANKLIN ST |
| City | WATERBURY |
| State | CT |
| Zip Code | 06706-1221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114929379 | Scovill Medical Group, PC | Internal Medicine | 56 Franklin St, Waterbury, CT 06706-1221 | 2005-06-01 |
| 1528676459 | Kate Marie Breiner | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-07-16 |
| 1417575192 | Muhammad Tasawar Latif | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-07-09 |
| 1013534148 | Syed Mustajab Ahmed | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-07-06 |
| 1558989681 | Brooj Awan | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-07-06 |
| 1699398438 | Michelle Lauren Yeung | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-05-27 |
| 1841810967 | Diana Shapoval | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-04-18 |
| 1235768649 | Sean Michael Burgwardt | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-04-07 |
| 1043849326 | Miguel Angel Bravo Jr. | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-04-07 |
| 1053948430 | Bhavya Vemuri | Student in an Organized Health Care Education/Training Program | 56 Franklin St, Waterbury, CT 06706-1253 | 2020-03-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245750538 | Sameerah Ibtisam Rehmani | Internal Medicine | St Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706 | 2017-06-27 |
| 1417208448 | Sherry L Gatling | Durable Medical Equipment & Medical Supplies | 394 Mill Street, 2nd Flr N, Waterbury, CT 06706 | 2012-10-01 |
| 1144505538 | Amanda Maria Delcavo | Physician Assistant | 50 Franklin Street, Waterbury, CT 06706 | 2011-10-17 |
| 1508097031 | Lauren K Ayr-volta | Clinical Neuropsychologist | 133 Scovill Street, Suite 211, Waterbury, CT 06706 | 2009-07-31 |
| 1538206800 | John Chardavoyne | Psychiatry & Neurology | Waterbury Outpatient Clinic, 95 Scovill Street, Waterbury, CT 06706 | 2007-01-30 |
| 1922111632 | Thomas Owen Genese | Internal Medicine | 56 Franklin Street, St. Mary's Hospital - Dept of Medicine, Waterbury, CT 06706 | 2006-08-16 |
| 1013942465 | Nancy Lou Kline | Nurse Practitioner | 133 Scovill Street-waterbury Va Community Based Clinic, #203, Waterbury, CT 06706 | 2006-07-12 |
| 1366823783 | Yamini Sachan | Internal Medicine | 56 Franklin Street, Waterbury, CT 06706 | 2015-06-11 |
| 1962881896 | Daniyal Ahmed Ansari | Internal Medicine | 56 Franklin Street, Saint Mary's Hospital, Waterbury, CT 06706 | 2015-05-26 |
| 1164809885 | Vanessa N. Goyes Ruiz | Student in an Organized Health Care Education/Training Program | 56 Franklin Street, Waterbury, CT 06706 | 2015-05-01 |
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| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609362847 | Nancy Elaine Rizza | Physician Assistant | 1389 W Main St Ste 120, Waterbury, CT 06708-3104 | 2018-07-10 |
| 1154516672 | Matthew Letko | Physician Assistant | 1389 W Main Street, Suite 120, Waterbury, CT 06708-3104 | 2007-09-07 |
| 1851439244 | Sara Whipple Coles | Physician Assistant | 8 S Commons Rd, Waterbury, CT 06704-1035 | 2007-02-01 |
| 1083237861 | Shalima Abdalla | Physician Assistant | 402 E Main St, Waterbury, CT 06702-1701 | 2020-05-27 |
| 1083269575 | Leslie Diaz | Physician Assistant | 141 E Main St, Waterbury, CT 06702-2310 | 2019-08-02 |
| 1053813220 | Dylan Stempel | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1253 | 2018-03-05 |
| 1538617204 | Kayla N Ingram | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1238 | 2016-09-12 |
| 1710338058 | Jaclyn Milano | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1253 | 2016-06-28 |
| 1902255086 | Kaitlyn Jennings | Physician Assistant | 56 Franklin St, Waterbury, CT 06706 | 2016-06-08 |
| 1245613199 | Kalin Haley | Physician Assistant | 56 Franklin St, Waterbury, CT 06706-1253 | 2015-07-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.