Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Avery Caroline Broderick

Individual provider Physician Assistant · NPI 1356022198

Avery Caroline Broderick is a Physician Assistant in Killingworth, Connecticut. Qualified in 2023, 3 years ago. Practices with Northeast Medical Group Inc, a 1,360-clinician group and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
3
Licensed in
CT
In the registry since
2023

Practice location Address checks out

63 Parker Hill Road Ext
Killingworth, CT 06419-2311
Phone: (203) 937-2309
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 6173 (CT)

Record details

NPI number1356022198
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 25, 2023
Last updated in NPPESNovember 6, 2025
Certification dateNovember 6, 2025
Mailing address5 Pamela Ln, South Salem, NY 10590-1115

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Northeast Medical Group Inc — 1360 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Killingworth