Provider Demographics
NPI:1962519538
Name:BRODY, MARK L (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4723 WEST ATLANTIC AVE
Mailing Address - Street 2:A-7
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-374-8461
Mailing Address - Fax:561-374-8463
Practice Address - Street 1:4723 WEST ATLANTIC AVE
Practice Address - Street 2:A-7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-374-8461
Practice Address - Fax:561-374-8463
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME712362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31685ZMedicare ID - Type Unspecified
E96604Medicare UPIN