Healthcare Provider Details

I. General information

NPI: 1013208032
Provider Name (Legal Business Name): LINDA EVONNE BROGDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26005 RIDGE RD STE 200
DAMASCUS MD
20872-1899
US

IV. Provider business mailing address

26005 RIDGE RD STE 200
DAMASCUS MD
20872-1899
US

V. Phone/Fax

Practice location:
  • Phone: 301-414-2300
  • Fax: 301-414-2306
Mailing address:
  • Phone: 301-414-2300
  • Fax: 301-414-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0083247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: