Healthcare Provider Details

I. General information

NPI: 1578214110
Provider Name (Legal Business Name): CAROLINE BROHAWN LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD STE 207
TOWSON MD
21286-3107
US

IV. Provider business mailing address

6905 BONNIE RIDGE DR APT 202
BALTIMORE MD
21209-5169
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4222
  • Fax:
Mailing address:
  • Phone: 301-802-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02877
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: