Kevin Broderick

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

D84883 Issued in MD

Practice address

8901 Wisconsin Ave
Bethesda, MD 20889-6956

Phone

(301) 295-1339

NPI assigned

Jan 5, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

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 and National Provider Directory roles.

• Children's Hospital

  • Children's Hospital
  • Washington, DC
  • NPI 1912939703

  Multi-Specialty

  Medicare reassignment NPD
• Children's Hospital

  dba Children's National Specialty Pharmacy

  • Community/Retail Pharmacy
  • Silver Spring, MD
  • NPI 1326878349
  NPD
• Children's Hospital

  dba Children's National Medical Associates

  • Pediatrics Physician
  • Washington, DC
  • NPI 1780800128

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1639449721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9706 DEEP SMOKE",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210462807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 WISCONSIN AVE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208896956",
            "telephone_number": "301-295-1339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7501 Greenway Center Dr # 300",
            "address_purpose": "LOCATION",
            "city": "Greenbelt",
            "state": "MD",
            "postal_code": "207703514",
            "country_code": "US",
            "telephone_number": "301-474-4679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "660 Pennsylvania Ave SE Frnt 2",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "20003",
            "country_code": "US",
            "telephone_number": "202-331-1188",
            "fax_number": "202-833-8872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5454 Wisconsin Ave Ste 650",
            "address_purpose": "LOCATION",
            "city": "Chevy Chase",
            "state": "MD",
            "postal_code": "208156956",
            "country_code": "US",
            "telephone_number": "301-656-8100",
            "fax_number": "301-652-2957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-05",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MD",
            "license": "D84883",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "DC",
            "license": "MD045933",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "VA",
            "license": "0101264466",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "DC",
            "license": "MD45933",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639449721",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clayton Brittingham, DO
• Kraig Britton
• Aaron Brockshus, MD
• Camille Brod, MD
• Samuel Broder, M.D.
• Daniel Brodie, M.D.
• Allen Perry Brodnick, PT
• Ellen Brodsky, DDS
• Eric R Brodsky, MD
• Jane Brodsky, DMD MS

• Retina Specialist (Ophthalmology) Physician in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Retina Specialist (Ophthalmology) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; 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.