Basic Information
| Provider Information | |||||||||
| NPI: | 1346291549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRODSKY | ||||||||
| FirstName: | ANATOLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MERCED ST | ||||||||
| Address2: | INTERNAL MEDICINE DEPARTMENT | ||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945774201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104544010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 MERCED ST | ||||||||
| Address2: | INTERNAL MEDICINE DEPARTMENT | ||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945774201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104544010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD22865 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A72800 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080188871 | 01 | OR | RAILROAD MEDICARE PROVIDER NUMBER | OTHER | 287049 | 05 | OR | MEDICAID |