Individual
GORDON BRODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
375 E CENTER ST, MANCHESTER, CT 06040-4445
(860) 646-0166
(860) 643-7574
Mailing address
PO BOX 3249, VERNON, CT 06066-2149
(860) 872-2289
(860) 896-1425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017993
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080139932
MEDICARE RAIL ROAD
CT
Enumeration date
03/08/2006
Last updated
02/23/2015
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