Individual
MATTHEW CULLEN BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10500 MONTGOMERY RD, CINCINNATI, OH 45242-4402
(513) 865-2246
(513) 865-5596
Mailing address
4685 FOREST AVE STE C, CINCINNATI, OH 45212-3359
(513) 246-7914
(513) 852-8525
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
35.127068
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35.127068
OH MD LICENSE
OH
Enumeration date
04/04/2012
Last updated
05/23/2017
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