Broderick, Kelly Clark

Broderick, Kelly Clark is an individual health care provider with primary practice located at 100 S San Mateo Dr , San Mateo CA 94401-3805. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Ultrasound, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is her primary health care specialty. Broderick, Kelly Clark can be contacted via phone (650) 696-4515.

Contact Information

Primary practice address
100 S San Mateo Dr San Mateo CA 94401-3805
Phone: (650) 696-4515
Fax: (650) 696-4626
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Ultrasound 2085U0001X G78759 California
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X G78759 California

Profile Details

NPI number 1609821891
LBN Legal business name Broderick, Kelly Clark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Sep 23rd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609821891 NPPES
California MEDICAID 00G787590
California Other 300121792
California Other 00G787590
California Other 300121755

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