Provider Demographics
NPI:1609838341
Name:BRODIE, DORA MIROSLAVA (MD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:MIROSLAVA
Last Name:BRODIE
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:
Practice Address - Street 1:520 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1127
Practice Address - Country:US
Practice Address - Phone:336-547-1700
Practice Address - Fax:336-547-1828
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20161207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4098074OtherAETNA PROVIDER NUMBER
NC27058OtherMEDCOST PROVIDER NUMBER
NC616OtherPARTNERS MEDICARE PROV #
NC8951893Medicaid
NC51893OtherBCBS NC PROVIDER NUMBER
NC4098074OtherAETNA PROVIDER NUMBER
NC205032BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER