Healthcare Provider Details

I. General information

NPI: 1457384950
Provider Name (Legal Business Name): ROBERTA BRAUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 RIVA RD SUITE 112
ANNAPOLIS MD
21401-7428
US

IV. Provider business mailing address

200 GOOSE HILL MANOR RD
STEVENSVILLE MD
21666-3041
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-1000
  • Fax: 410-573-4028
Mailing address:
  • Phone: 410-643-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0025928
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: