Provider Demographics
NPI:1235174483
Name:BROD, ROY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:DAVID
Last Name:BROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARRISBURG PIKE STE 370
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-399-8790
Mailing Address - Fax:717-399-3279
Practice Address - Street 1:2150 HARRISBURG PIKE STE 370
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-399-8790
Practice Address - Fax:717-399-3279
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039715L207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001134072Medicaid
PA428401Medicare ID - Type Unspecified
PA001134072Medicaid