Individual
KEVIN J BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 COMPASS WAY, SUITE 102, EAST BRIDGEWATER, MA 02333-1465
(508) 350-2100
(508) 350-2314
Mailing address
362 N BEDFORD ST, EAST BRIDGEWATER, MA 02333-1148
(508) 350-2350
(508) 350-2318
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
204113
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204113
TAHP
MA
01
—
713262
HPHC
MA
01
—
J24406
BC/BS
MA
01
—
SX3393
MEDICARE PTAN
MA
Enumeration date
06/01/2006
Last updated
03/07/2016
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