Healthcare Provider Details

I. General information

NPI: 1770627176
Provider Name (Legal Business Name): MARC FRANCIS BRAZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE SUITE 202
CLINTON MD
20735-1642
US

IV. Provider business mailing address

7801 OLD BRANCH AVE SUITE 202
CLINTON MD
20735-1642
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-9414
  • Fax:
Mailing address:
  • Phone: 301-868-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0068604
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101245136
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: