Avery Caroline Broderick, is a medicare enrolled "Physician Assistant" in Killingworth, Connecticut. She graduated from nursing school in 2023 and has 2 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Northeast Medical Group Inc and her current practice location is
63 Parker Hill Road Ext, Killingworth, Connecticut. You can reach out to her office (for appointments etc.) via phone at
(203) 937-2309.
Avery Caroline Broderick is licensed to practice in Connecticut (license number 6173) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1356022198.
Provider's Profile
| Full Name | Avery Caroline Broderick |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 2 Years |
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| Location | 63 Parker Hill Road Ext, Killingworth, Connecticut |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Avery Caroline Broderick graduated from nursing school in 2023
NPI Data:
- NPI Number: 1356022198
- Provider Enumeration Date: 07/25/2023
- Last Update Date: 11/06/2025
Medicare PECOS Information:
- PECOS PAC ID: 7416303995
- Enrollment ID: I20231020000503
Medical Identifiers
Medical identifiers for Avery Caroline Broderick such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356022198 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 6173 (Connecticut) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Northeast Medical Group Inc | 1254233836 | 1287 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Avery Caroline Broderick is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Avery Caroline Broderick,
5 Pamela Ln,
South Salem, NY 10590-1115
Ph: (631) 697-1468 | Avery Caroline Broderick,
63 Parker Hill Road Ext,
Killingworth, CT 06419-2311
Ph: (203) 937-2309 |
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