Broderick, Kevin

Broderick, Kevin is an sole proprietor health care provider with primary practice located at 5454 Wisconsin Ave Ste 650 , Chevy Chase MD 20815-6956. He recently has 3 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Retina Specialist, Allopathic & Osteopathic Physicians / Ophthalmology. Allopathic & Osteopathic Physicians / Retina Specialist is his primary health care specialty. Broderick, Kevin can be contacted via phone (301) 656-8100.

Contact Information

Primary practice address
5454 Wisconsin Ave Ste 650 Chevy Chase MD 20815-6956
Phone: (301) 656-8100
Fax: (301) 652-2957
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X D84883 Maryland
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD045933 District of Columbia
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X 0101264466 Virginia
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X MD45933 District of Columbia

Profile Details

NPI number 1639449721
LBN Legal business name Broderick, Kevin
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 5th, 2012
Last updated Nov 6th, 2019 - about 5 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 1639449721 NPPES
Virginia MEDICAID 1639449721

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