Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D0035190 | MD |
Y | 2080N0001X | Neonatal-Perinatal Doctor | D0035190 | MD |
NPI | 1013977073 |
---|---|
Provider Name | Karen A Broderick |
First Address | Baltimore, MD 21228 |
Second Address | Baltimore, MD 21229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
442791200 | (05) | MD |
C57687 | (02) | |
K51935153501 | CAREFIRST (01) | MD |
W6620094 | CAREFIRST (01) | DC |