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General NPI Number Information
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NPI Number | 1306051321
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Entity Type | Organization
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Legal Business Name | JOHN BRAXTON MD
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 1940 W BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21223-2245
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Country | US
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Telephone | 410-298-8223
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Fax | 410-298-8225
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Provider Business Mailing Address
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Address Line | 3206 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-7450
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Country | US
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Telephone | 410-367-5770
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Fax | 410-298-8225
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Authorized Official
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Title or Position | BILLING MGR
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Name | LOUISE MACY
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Credential |
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Telephone | 410-298-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0000516
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License Number State | MD
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