Provider Demographics
NPI:1023113008
Name:BROSMAN, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BROSMAN
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 22120
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925-2120
Mailing Address - Country:US
Mailing Address - Phone:843-681-5062
Mailing Address - Fax:843-681-5063
Practice Address - Street 1:11 HOSPITAL CENTER CMNS
Practice Address - Street 2:SUITE 100
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2844
Practice Address - Country:US
Practice Address - Phone:843-681-5062
Practice Address - Fax:843-681-5063
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15288208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42D1094640OtherCLIA
SCGP3893Medicaid
SC42D1094640OtherCLIA
SC7821Medicare ID - Type Unspecified
SC6409370001Medicare NSC