Provider Demographics
NPI:1578777355
Name:BRODERICK, MEREDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 112TH AVE NE
Mailing Address - Street 2:STE 307
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3759
Mailing Address - Country:US
Mailing Address - Phone:425-278-2250
Mailing Address - Fax:425-562-5885
Practice Address - Street 1:1100 112TH AVE NE
Practice Address - Street 2:SUITE 320
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4511
Practice Address - Country:US
Practice Address - Phone:425-289-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601056302084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8861543Medicare PIN