| Ronald L. Broadwater Sr. M.d.pa | |
|
12 Brecon Pl Suite 400 Cockeysville MD 21030-2343 | |
| (443) 281-8086 | |
| (443) 281-8117 |
| Full Name | Ronald L. Broadwater Sr. M.d.pa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 12 Brecon Pl, Cockeysville, Maryland |
| Authorized Official Name and Position | Ronald Lee Broadwater (OWNER/MEDICAL PROVIDER) |
| Authorized Official Contact | 4432818086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ronald L. Broadwater Sr. M.d.pa 12 Brecon Pl Suite 400 Cockeysville MD 21030-2343 Ph: (443) 281-8086 | Ronald L. Broadwater Sr. M.d.pa 12 Brecon Pl Suite 400 Cockeysville MD 21030-2343 Ph: (443) 281-8086 |
| NPI Number | 1497051395 |
|---|---|
| Provider Enumeration Date | 02/10/2011 |
| Last Update Date | 03/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497051395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D15200 (Maryland) | Primary |
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