Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD442568 | PA |
N | 208000000X | Pediatrician | 0101243146 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 0101243146 | VA |
NPI | 1023279148 |
---|---|
Provider Name | Richard A Brodsky |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0271314 | (05) | NJ |