Individual
SCOTT RUSSELL BROADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Mailing address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2008-01123
NC
2085R0202X
Diagnostic Radiology Physician
31804
SC
2085R0204X
Vascular & Interventional Radiology Physician
2008-01123
NC
2085R0204X
Vascular & Interventional Radiology Physician
31804
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909660
—
NC
05
—
N23008
—
SC
01
—
P00655691
RR NC MEDICARE
NC
Enumeration date
11/08/2005
Last updated
12/20/2017
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