Provider Demographics
NPI:1790837896
Name:BRODKIN, CARL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ANDREW
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 1:3607 47TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5351
Mailing Address - Country:US
Mailing Address - Phone:206-523-4180
Mailing Address - Fax:206-523-0815
Practice Address - Street 1:3607 47TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5351
Practice Address - Country:US
Practice Address - Phone:206-523-4180
Practice Address - Fax:206-523-0815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine