Theresa Broderick, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101247997 Issued in VA

Practice address

23 Manhattan SQ
Hampton, VA 23666-5843

Phone

(757) 224-1600

Fax

(757) 825-1316

NPI assigned

May 22, 2007

Last updated

May 13, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Childrens Specialty Group PLLC

  • Pediatrics Physician
  • Norfolk, VA
  • NPI 1255354130
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1568672459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 MANHATTAN SQ",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665843",
            "telephone_number": "757-224-1600",
            "fax_number": "757-825-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 MANHATTAN SQ",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665843",
            "telephone_number": "757-224-1600",
            "fax_number": "757-825-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "THERESA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101247997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broadus International Group Network, LLC
• Katesha Shanee Broadus, LCSW, BC-TMH
• Mandi Leigh Payne Brock, M.D.
• Laurel Olivia Brockenberry, PHD
• Elizabeth Broderick, MD
• Debra Ann Brooks, LCSW
• Kymberlie Sherri Brooks, LPC
• Latasha A Brooks, FNP-C
• Nichole Marie Brooks, NP-C
• Yvonne Taniesha Brooks, LCSW

• Pediatrics Physician in Hampton, VA
• Providers in Hampton, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.