Provider Demographics
NPI:1073676771
Name:BRODIE, ROBIN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:BRODIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SUDLEY RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4419
Mailing Address - Country:US
Mailing Address - Phone:703-393-9494
Mailing Address - Fax:703-393-8591
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4419
Practice Address - Country:US
Practice Address - Phone:703-393-9494
Practice Address - Fax:703-393-8591
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047636208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006728189Medicaid
259950OtherUNITED HEALTHCARE MAMSI
50320002OtherCAREFIRST
334843OtherANTHEM HEALTHKEEPERS PLUS
480340OtherAETNA
8154105OtherUNITED HEALTHCARE MAMSI
2154105OtherUNITED HEALTH CARE
F69889Medicare UPIN