Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R72561 | AZ |
Y | 2080P0205X | Pediatric Endocrinologist | D77689 | MD |
NPI | 1215215546 |
---|---|
Provider Name | Dr. Miranda Marguerite Broadney |
First Address | Baltimore, MD 21201-1009 |
Second Address | Baltimore, MD 21201-4606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 15/04/2019 |