Provider Demographics
NPI:1982658423
Name:BRODSKY, LEONID MIKHAILOVICH (MD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:MIKHAILOVICH
Last Name:BRODSKY
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 1:11 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-3325
Mailing Address - Country:US
Mailing Address - Phone:207-255-0460
Mailing Address - Fax:207-255-0289
Practice Address - Street 1:11 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3325
Practice Address - Country:US
Practice Address - Phone:207-255-0460
Practice Address - Fax:207-255-0289
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016091207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME050091003OtherRAILROAD MEDICARE
ME044334OtherANTHEM OF MAINE
ME050091003OtherRAILROAD MEDICARE