Provider Demographics
NPI:1083001986
Name:BRODERICK, ERIN (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST 27TH STREET
Mailing Address - Street 2:SOUTHEASTERN HEALTH
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-272-1478
Mailing Address - Fax:910-671-5392
Practice Address - Street 1:300 WEST 27TH STREET
Practice Address - Street 2:SOUTHEASTERN HEALTH
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28359
Practice Address - Country:US
Practice Address - Phone:910-272-1478
Practice Address - Fax:910-671-5392
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209926207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine