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Kelly Clark Broderick, MD
Diagnostic Radiology Physician in San Mateo, California
NPI 1609821891

Kelly Clark Broderick is a Diagnostic Radiology Physician based in Novato, CA and is specialized in Diagnostic Radiology. Kelly Clark Broderick practices in San Mateo, CA and has the professional credentials of MD. The NPI Number for Kelly Clark Broderick is 1609821891 and holds a License No. G78759 (California).

The current practice location address for Kelly Clark Broderick is 100 S San Mateo Dr, San Mateo, CA and can be reached out via phone at 650-696-4515 and via fax at 650-696-4626.

Location: 100 S San Mateo Dr, San Mateo, CA, 94948-6102
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609821891
Provider Name
Kelly Clark Broderick
Credential
MD
Provider Entity Type
Individual
Gender
Female
Address
100 S San Mateo Dr, San Mateo, CA, 94948-6102
Phone Number
650-696-4515
Fax Number
650-696-4626
Provider Enumeration Date
05/24/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00G787590 05 CA
300121792 01 CA RAILROAD MEDICARE
00G787590 01 CA BLUE CROSS
300121755 01 CA RAILROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
100 S San Mateo Dr
City
San Mateo
State
California
Zip
94401-3805
Phone Number
650-696-4515
Fax Number
650-696-4626
person
Provider Business Mailing Address Details
Address
100 S San Mateo Dr
City
San Mateo
State
California
Zip
94401-3805
Phone Number
650-696-4515
Fax Number
650-696-4626
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
2085R0202X
License No.
G78759 (California)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Ultrasound
Taxonomy
2085U0001X
License No.
G78759 (California)
Definition
A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound.
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