DR. JOHN JOSEPH BRODERICK-CANTWELL M.D. NPI 1760493365

NPI Information

NPI: 1760493365
Provider Name: DR. JOHN JOSEPH BRODERICK-CANTWELL, M.D.
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
7101 US HIGHWAY 90 STE 103
DAPHNE, AL
ZIP 36526
Phone: (251) 517-5800
Get Directions

DR. John Joseph Broderick-cantwell, M.D. is a child and adolescent psychiatry psychiatry neurology in Daphne, AL with 37 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. DR. John Joseph Broderick-cantwell, M.D. NPI is 1760493365. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduation Year:1987

The provider's business location address is:

7101 US HIGHWAY 90 STE 103
DAPHNE, AL
ZIP 36526-510
Phone: (251) 517-5800
Fax: (256) 429-9411

The NPI 1760493365 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 2/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	28950	ALABAMA	No
2	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	28950	ALABAMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	28903	OTHER	SOUTH CAROLINA	MEDICAL LICENSE
2	Q48343	MEDICAID	SOUTH CAROLINA
3	1353044	MEDICAID	COLORADO
4	DR-35304	OTHER	COLORADO	MEDICAL LICENSE
5	28950	OTHER	ALABAMA	MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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