Basic Information
| Provider Information | |||||||||
| NPI: | 1609838341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRODIE | ||||||||
| FirstName: | DORA | ||||||||
| MiddleName: | MIROSLAVA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 520 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471700 | ||||||||
| FaxNumber: | 3365471828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20161 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 20161 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 4098074 | 01 | NC | AETNA PROVIDER NUMBER | OTHER | 27058 | 01 | NC | MEDCOST PROVIDER NUMBER | OTHER | 616 | 01 | NC | PARTNERS MEDICARE PROV # | OTHER | 8951893 | 05 | NC | MEDICAID | 51893 | 01 | NC | BCBS NC PROVIDER NUMBER | OTHER |