NPI 1639449721 · live from the CMS NPI Registry
Kevin Broderick
Ophthalmology, Retina Specialist in Bethesda, MD. National Provider Identifier 1639449721, active.
NPI record
| NPI | 1639449721 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Ophthalmology, Retina Specialist 207WX0107X |
| Practice location | 8901 Wisconsin Ave, Bethesda, MD 20889 |
| Practice phone | 301-295-1339 |
| Mailing address | 9706 Deep Smoke, Columbia, MD 21046 |
| Enumerated | January 5, 2012 |
| Last updated | March 21, 2025 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Ophthalmology, Retina Specialist primary | 207WX0107X | D84883 (MD) |
| Ophthalmology | 207W00000X | MD045933 (DC) |
| Ophthalmology, Retina Specialist | 207WX0107X | 0101264466 (VA) |
| Ophthalmology, Retina Specialist | 207WX0107X | MD45933 (DC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.