Provider Demographics
NPI:1962654335
Name:DAVID S BRODY, MD
Entity Type:Organization
Organization Name:DAVID S BRODY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-748-2123
Mailing Address - Street 1:1290 HOSPITAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9205
Mailing Address - Country:US
Mailing Address - Phone:802-748-2123
Mailing Address - Fax:
Practice Address - Street 1:1290 HOSPITAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9205
Practice Address - Country:US
Practice Address - Phone:802-748-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty