Provider Demographics
NPI:1609846385
Name:BRODKIN, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BRODKIN
Suffix:
Gender:M
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:PO BOX 75216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-5216
Mailing Address - Country:US
Mailing Address - Phone:704-873-5150
Mailing Address - Fax:704-873-5208
Practice Address - Street 1:276 OLD MOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1949
Practice Address - Country:US
Practice Address - Phone:704-873-5150
Practice Address - Fax:704-873-5208
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20109207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00031308OtherRAILROAD MEDICARE
VA006005314Medicaid
3130882OtherAETNA HMO
4098090OtherAETNA PPO
NC7918565Medicaid
NC118OtherPARTNERS NATIONAL HEALTH
21406OtherMEDCOST
3601026OtherUNITED HEALTH CARE
NC18565OtherBLUE CROSS AND BLUE SHIEL
NC205034EMedicare PIN
NC205034DMedicare PIN
NC18565OtherBLUE CROSS AND BLUE SHIEL