Healthcare Provider Details

I. General information

NPI: 1134461569
Provider Name (Legal Business Name): CAMILLE ANGELA BROUSSARD M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2013
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORBES ST STE 200
ANNAPOLIS MD
21401-1527
US

IV. Provider business mailing address

200 FORBES ST STE 200
ANNAPOLIS MD
21401-1599
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-6363
  • Fax: 410-263-7551
Mailing address:
  • Phone: 410-263-6363
  • Fax: 410-263-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0081897
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberD0081897
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: