Provider Demographics
NPI:1467550285
Name:BRODSKY, BARI-SUE (MD)
Entity Type:Individual
Prefix:
First Name:BARI-SUE
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WATER ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4812
Mailing Address - Country:US
Mailing Address - Phone:781-648-9700
Mailing Address - Fax:781-648-0234
Practice Address - Street 1:11 WATER ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4812
Practice Address - Country:US
Practice Address - Phone:781-648-9700
Practice Address - Fax:781-648-0234
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3132331Medicaid
MA5107980OtherCIGNA
MA989704OtherNETWORK HEALTH
MAJ30937OtherBCBS
MA24941OtherFALLON
MA70655OtherHARVARD PILGRIM HEALTH
MA080150OtherTUFTS HEALTH PLAN
MA4564201OtherAETNA
MA5107980OtherCIGNA
MA4564201OtherAETNA