Most Relevant Information
Provider Data
| NPI Number: | 1003031154 |
| Provider Name: | MICHAEL S. BRODER PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103T00000X |
| Specialty: | Psychologist |
| License Number: | PS003069-L |
Most Important Dates
| Enumeration Date: | 04/16/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1420 LOCUST ST
7G
PHILADELPHIA
PA
191024223
Practice Location Phone/Fax
| Phone: | 2155457000 |
| Fax: | 2155457011 |
Provider Mailing Location
1420 LOCUST ST
7G
PHILADELPHIA
PA
191024223
Provider Mailing Phone/Fax
| Phone: | 2155457000 |
| Fax: | 2155457011 |