Provider Demographics
NPI:1295769685
Name:BRODSKY, MARC ERIC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ERIC
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN STE 205
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-2918
Mailing Address - Country:US
Mailing Address - Phone:203-276-4777
Mailing Address - Fax:203-276-4778
Practice Address - Street 1:75 HOLLY HILL LN STE 205
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2918
Practice Address - Country:US
Practice Address - Phone:203-276-4777
Practice Address - Fax:203-276-4778
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046965208VP0000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine