Healthcare Provider Details

I. General information

NPI: 1992007827
Provider Name (Legal Business Name): TLC PERINATAL RICHARD BROTH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
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: RICHARD ELLIOT BROTH
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 301-681-0004