Provider Demographics
NPI:1558381012
Name:BROADY, RONDA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:LYNN
Last Name:BROADY
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 1:1055 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3446
Mailing Address - Country:US
Mailing Address - Phone:610-431-0865
Mailing Address - Fax:
Practice Address - Street 1:1055 ANDREW DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3446
Practice Address - Country:US
Practice Address - Phone:610-431-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA102202230207Q00000X
DEC20006590207Q00000X
PAOS011005L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558381012Medicaid
VAH69177Medicare UPIN
VA1558381012Medicaid
H69177Medicare UPIN