KEVIN BRODERICK (NPI# 1639449721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639449721 |
| Entity Type | Individual |
| Full Name | KEVIN BRODERICK |
| Practice Address |
5454 Wisconsin Ave Ste 650 Chevy Chase MD 20815-6956 |
| Mailing Address |
9706 Deep Smoke Columbia MD 21046-2807 |
| Practice Telephone | 3016568100 |
| Practice Fax Number | 3016522957 |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2019-11-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | MD045933 | DC | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care | ||
| N | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
MD45933 | DC | Allopathic & Osteopathic Physicians |
| N | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
0101264466 | VA | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
D84883 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1639449721 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5454 Wisconsin Ave Ste 650, Chevy Chase, MD 208156956 | 3016568100 | 3016522957 |
| 660 Pennsylvania Ave Se Frnt 2, Washington, DC 20003 | 2023311188 | 2028338872 |
| 7501 Greenway Center Dr # 300, Greenbelt, MD 207703514 | 3014744679 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255485793 | Kevin Dee Broderick | Marriage & Family Therapist | 94 E Pages Ln Ste A, Centerville, UT 84014-2216 | 2007-01-22 |
| 1487251864 | Kevin Broderick | Student in an Organized Health Care Education/Training Program | 165 Main St. Ste A, Cortland, NY 13045-3049 | 2020-10-08 |
| 1013954759 | Kevin J Broderick | Family Medicine | 1 Compass Way, Suite 102, East Bridgewater, MA 02333-1465 | 2006-06-01 |
| Street Address |
5454 WISCONSIN AVE STE 650 |
| City | CHEVY CHASE |
| State | MD |
| Zip Code | 20815-6956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831163997 | Richard A Garfinkel | Ophthalmology | 5454 Wisconsin Ave Ste 650, Chevy Chase, MD 20815-6956 | 2006-02-15 |
| 1073807681 | Brian K. Do | Ophthalmology | 5454 Wisconsin Ave Ste 650, Chevy Chase, MD 20815-6956 | 2011-06-01 |
| 1174718456 | Gayatri Reilly | Ophthalmology | 5454 Wisconsin Ave Ste 650, Chevy Chase, MD 20815-6956 | 2007-09-11 |
| 1962432260 | Michael Min-shyue Lai | Ophthalmology | 5454 Wisconsin Ave Ste 650, Chevy Chase, MD 20815 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306456454 | Sarah Trandel-korenchuk | Nurse Practitioner | 4622 Norwood Drive, Chevy Chase, MD 20815 | 2020-08-04 |
| 1730709254 | Lorelyn Pierola | Physical Therapist | 8700 Jones Mill Road, Chevy Chase, MD 20815 | 2020-04-24 |
| 1194292391 | Bradley T Nguyen | Student in an Organized Health Care Education/Training Program | 5454 Wisconsic Ave, Bethesda, MD 20815 | 2018-10-26 |
| 1053897652 | Seth Parker Worthing | Orthopaedic Surgery | 5454 Wisconsin Ave Ste 1000, Chevy Chase, MD 20815 | 2018-07-17 |
| 1104310382 | Brendan F. Burke, M.d., L.L.C. | Obstetrics & Gynecology | 5530 Wisconsin Ave Ste 850, Chevy Chase, MD 20815 | 2018-06-20 |
| 1740778240 | Miriam Brazer | Student in an Organized Health Care Education/Training Program | 4810 Bradley Blvd, Chevy Chase, MD 20815 | 2018-04-30 |
| 1285131201 | Juventino Aceves | Speech-Language Pathologist | 5530 Wisconsin, Chevy Chase, MD 20815 | 2018-04-06 |
| 1386167351 | Seth A. Greenblatt | Social Worker | 2 Wisconsin Circle, Suite 700, Your Health Concierge, Inc, Bethesda, MD 20815 | 2017-07-21 |
| 1932636990 | Katelyn Marie Engbert | Registered Nurse | 4717 Morgan Dr, Chevy Chase, MD 20815 | 2017-05-20 |
| 1043752512 | Erin Leeland Nes | Marriage & Family Therapist | 4405 East West Highway Suite 408, Bethesda, MD 20815 | 2016-11-15 |
| Find all providers in zip 20815 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588296610 | Retina First LLC | Ophthalmology | 1502 S Main St Ste 305, Mount Airy, MD 21771-5374 | 2020-02-06 |
| 1912423567 | Panos George Christakis | Ophthalmology | 10 Center Drive; Building 10-crc, Bethesda, MD 20892-0001 | 2017-08-16 |
| 1831620020 | Greater Baltimore Vitreoretinal Specialists, LLC | Ophthalmology | 2327 Boston St, Unit 1, Baltimore, MD 21224-3672 | 2017-03-21 |
| 1659714707 | Sidney Ariel Schechet | Ophthalmology | 9114 Philadelphia Rd Ste 310, Baltimore, MD 21237-4350 | 2013-04-08 |
| 1801057146 | Joshua Kiran Fernandes | Ophthalmology | 2101 Medical Park Dr Ste 303, Silver Spring, MD 20902-4053 | 2008-06-19 |
| 1205857349 | Robert E. Parnes, M.d., LLC | Ophthalmology | 246 Eastern Blvd N Ste 102, Hagerstown, MD 21740 | 2006-07-22 |
| 1760421929 | Michael Joel Elman | Ophthalmology | 9114 Philadelphia Road, Suite 310, Baltimore, MD 21237-2123 | 2006-06-05 |
| 1427055144 | Fadi Philip Nasrallah | Ophthalmology | 6720a Rockledge Dr Ste 200, Bethesda, MD 20817-1888 | 2005-07-07 |
| 1568973444 | Maryland Retina Institute LLC | Ophthalmology | 2919 Olney Sandy Spring Rd Ste D, Olney, MD 20832 | 2017-10-18 |
| 1235487042 | Sadiq N Syed Md LLC | Ophthalmology | 5963 Exchange Dr, Suite 108, Sykesville, MD 21784-9251 | 2012-08-28 |
| Find all providers with the same taxonomy | ||||
| City | CHEVY CHASE |
| Zip Code | 20815 |
Please comment or provide details below to improve the information on KEVIN BRODERICK.
| 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.