Healthcare Provider Details

I. General information

NPI: 1508854555
Provider Name (Legal Business Name): RICHARD E BROTH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR SUITE 300
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR SUITE 300
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-0004
  • Fax: 512-532-0871
Mailing address:
  • Phone: 301-681-0004
  • Fax: 512-532-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD0064574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: