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NPI Code Detail

MEDICARE: MICHAEL BROUGHTON

MEDICARE: MICHAEL BROUGHTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLC200004121DC

General Provider Information

NPI Number : 1780517755
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BROUGHTON
Provider Business Mailing Address
First Line : 3620 11TH ST NW APT 1
Second Line :
City : WASHINGTON
State : DC
Zip : 20010-1485
Country : US
Telephone Number : 914-462-9024
Fax Number :
Provider Business Practice Location Address
First Line : 1313 NEW YORK AVE NW BSMT
Second Line :
City : WASHINGTON
State : DC
Zip : 20005-4701
Country : US
Telephone Number : 202-420-9707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ MICHAEL BROUGHTON ” Practice Location

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