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:
Health care specialties
| Specialty | Code | License # | 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 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639449721 | NPPES |
| Virginia | MEDICAID | 1639449721 |
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