Provider Demographics
NPI:1376790154
Name:BRODSKY, SERGEY V (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:V
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-9258
Mailing Address - Fax:614-293-4255
Practice Address - Street 1:333 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1239
Practice Address - Country:US
Practice Address - Phone:614-293-9258
Practice Address - Fax:614-293-4255
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090653207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939575Medicaid