SAMUEL B BROADDUS (NPI# 1326094335) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326094335 |
| Entity Type | Individual |
| Full Name | SAMUEL B BROADDUS |
| Credential | MD |
| Practice Address |
81 Medical Center Dr Suite 2350 Brunswick ME 04011-2764 |
| Practice Telephone | 2073736690 |
| Practice Fax Number | 2073736695 |
| Mailing Telephone | 2073736690 |
| Mailing Fax Number | 2073736695 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-01-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD11648 | ME | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NH | 30007671 | 05 | |
| ME | 263730099 | 05 |
| Street Address |
81 MEDICAL CENTER DR SUITE 2350 |
| City | BRUNSWICK |
| State | ME |
| Zip Code | 04011-2764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275518144 | Jessica L Buckner | Podiatrist | 81 Medical Center Dr, Suite 2100, Brunswick, ME 04011-2690 | 2005-12-13 |
| 1598130411 | Rebecca Howe | Dietitian, Registered | 81 Medical Center Dr, Suite 2200, Brunswick, ME 04011-2764 | 2015-12-03 |
| 1588066203 | Carroll Clinical Consulting Pllc | Internal Medicine | 81 Medical Center Dr, Ste 1300, Brunswick, ME 04011-2764 | 2014-09-25 |
| 1780095786 | Claire Ross | Nurse Practitioner | 81 Medical Center Dr, Suite 2150, Brunswick, ME 04011-2764 | 2014-05-13 |
| 1104122936 | Michael David Kipp | Assistant, Podiatric | 81 Medical Center Dr, Suite 2100, Brunswick, ME 04011-2764 | 2011-01-26 |
| 1174764146 | Angela M. Perron Dpm Pa | Podiatrist | 81 Medical Center Dr, Suite 1150, Brunswick, ME 04011-2690 | 2009-03-20 |
| 1871767699 | Alison R Fernald | Nutritionist | 81 Medical Center Dr, Suite 2200, Brunswick, ME 04011-2764 | 2008-04-14 |
| 1699974097 | Jared T Wilkinson | Podiatrist | 81 Medical Center Dr, Suite 2100, Brunswick, ME 04011-2690 | 2007-07-16 |
| 1770703811 | Kristen Jane Schroeder-cyr | Nurse Practitioner | 81 Medical Center Dr, Suite 2300, Brunswick, ME 04011-2764 | 2007-04-30 |
| 1649312638 | Liana Belle Kelly | Nurse Practitioner | 81 Medical Center Dr, Ste 2200, Brunswick, ME 04011-2765 | 2007-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093276370 | Convenientmd LLC | Clinic/Center | 193 Bath Road, Brunswick, ME 04011 | 2019-03-28 |
| 1326571241 | Psychology Specialists of Maine | Psychologist | 14 Maine St., Suite 309, Brunswick, ME 04011 | 2017-04-07 |
| 1992249775 | Avita Brunswick LLC | Alzheimer Center (Dementia Center) | 89 Admiral Fitch Way, Brunswick, ME 04011 | 2016-12-13 |
| 1215303433 | Mary K Kunhardt | Social Worker | 116 Maquoit Rd, Brunswick, ME 04011 | 2015-08-12 |
| 1861803843 | Gretchen Jane Stevens | Counselor | 136 Maine Street, Suite #6, Brunswick, ME 04011 | 2014-05-13 |
| 1356764567 | Kid Function, Inc. | Clinic/Center | 225 Thomas Point Road, Brunswick, ME 04011 | 2014-01-23 |
| 1356788921 | Jacques M. Reynolds | Psychiatry & Neurology | 81 Medical Center Dr # 2400, Brunswick, ME 04011 | 2013-05-23 |
| 1922369891 | Charles Russell Thorp | Pharmacist | 147 Bath Rd, Rtes 1 and 24, Merry Meeting Plaza, Brunswick, ME 04011 | 2012-06-06 |
| 1992076111 | Benjamin C. Tyau | Physician Assistant | 193 Bath Rd, Brunswick, ME 04011 | 2012-01-19 |
| 1841575339 | Bluesage Therapies Inc. | Social Worker | 214 Raymond Road, Brunswick, ME 04011 | 2011-10-15 |
| Find all providers in zip 04011 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518034024 | Jack Marlin Amie Jr. | Urology | 2418 Parkwood Dr, Brunswick, GA 31520-4721 | 2006-11-29 |
| 1285692392 | James W Ross | Urology | 85 Baribeau Drive, Brunswick, ME 04011 | 2006-05-01 |
| 1033258074 | Matthew D Katz | Urology | 2500 Starling Street, Suite 602, Brunswick, GA 31520 | 2007-02-06 |
| 1205995651 | John F Mcgeough, Md | Urology | 85 Baribeau Dr, Brunswick, ME 04011-3249 | 2006-12-08 |
| 1073692174 | Joseph Anthony Lanzone Jr. | Urology | 2500 Starling St, Suite 406, Brunswick, GA 31520-4265 | 2006-11-02 |
| 1801975990 | Southeast Georgia Urology Associates PC | Urology | 2500 Starling St, Suite 406, Brunswick, GA 31520-4265 | 2006-11-02 |
| 1679652762 | James Morris Muse Jr. | Urology | 2500 Starling St, Suite 406, Brunswick, GA 31520-4265 | 2006-11-02 |
| 1518051481 | Michael R Curtis | Urology | 121 Medical Center Dr, Brunswick, ME 04011-2653 | 2006-10-03 |
| 1104932177 | John Francis Mcgeough | Urology | 85 Baribeau Dr, Brunswick, ME 04011-3249 | 2006-08-22 |
| 1659394112 | Craig A Hawkins | Urology | 81 Medical Center Dr, Suite 2350, Brunswick, ME 04011-2764 | 2006-07-25 |
| Find all providers in BRUNSWICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.