Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 233883 | MA |
NPI | 1114084191 |
---|---|
Provider Name | Dr. Genevieve B Broderick |
First Address | Quincy, MA 02169-0908 |
Second Address | Quincy, MA 02169-0908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 24/06/2015 |