Provider Demographics
NPI:1629030341
Name:BRODIE, BRUCE ROGERS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROGERS
Last Name:BRODIE
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 890195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0195
Mailing Address - Country:US
Mailing Address - Phone:336-547-1700
Mailing Address - Fax:
Practice Address - Street 1:1126 N CHURCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1000
Practice Address - Country:US
Practice Address - Phone:336-832-1700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18929207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4098065OtherAETNA PROVIDER NUMBER
NC21403OtherMEDCOST PROVIDER NUMBER
NC614OtherPARTNERS MEDICARE
NC8918562Medicaid
NC18562OtherBCBS NC PROVIDER NUMBER
NC8918562Medicaid
NC614OtherPARTNERS MEDICARE