Provider Demographics
NPI:1457986416
Name:BRODEY, BENJAMIN BORIS
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BORIS
Last Name:BRODEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 GIMGHOUL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3811
Mailing Address - Country:US
Mailing Address - Phone:919-942-5599
Mailing Address - Fax:
Practice Address - Street 1:201 E ROSEMARY ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-3529
Practice Address - Country:US
Practice Address - Phone:919-942-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004006452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry