Provider Demographics
NPI:1346566072
Name:JAMES H. BRODSKY, M.D.,P.C.
Entity Type:Organization
Organization Name:JAMES H. BRODSKY, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-6760
Mailing Address - Street 1:4701 WILLARD AVENUE
Mailing Address - Street 2:224
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4609
Mailing Address - Country:US
Mailing Address - Phone:301-652-6760
Mailing Address - Fax:310-652-6763
Practice Address - Street 1:4701 WILLARD AVE
Practice Address - Street 2:224
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4643
Practice Address - Country:US
Practice Address - Phone:301-652-6760
Practice Address - Fax:310-652-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC61550Medicare UPIN