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General NPI Number Information
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NPI Number | 1023234598
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Entity Type | Organization
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Legal Business Name | NANAKO BROUGHTON MD LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1145 19TH ST NW 510
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City | WASHINGTON
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State | DC
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Zip | 20036-3701
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Country | US
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Telephone | 202-296-7722
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Fax | 202-429-0967
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Provider Business Mailing Address
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Address Line | 1145 19TH ST NW 510
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City | WASHINGTON
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State | DC
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Zip | 20036-3701
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Country | US
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Telephone | 202-296-7722
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Fax | 202-429-0967
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANAKO BROUGHTON
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Credential | M.D.
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Telephone | 202-296-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD33594
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License Number State | DC
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