Provider Demographics
NPI:1801899489
Name:BRODERICK, DAWN (MD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-774-7714
Mailing Address - Fax:301-686-7164
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-7714
Practice Address - Fax:301-686-7164
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2015-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0045956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine