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General NPI Number Information
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NPI Number | 1619997491
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Entity Type | Individual
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Provider Name | JASON GABRIEL BROMER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 45 THOMAS JOHNSON DR SUITE 107
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City | FREDERICK
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State | MD
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Zip | 21702-4425
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Country | US
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Telephone | 301-631-1180
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Fax | 301-631-1299
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Provider Business Mailing Address
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Address Line | 45 THOMAS JOHNSON DR SUITE 107
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City | FREDERICK
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State | MD
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Zip | 21702-4425
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Country | US
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Telephone | 301-631-1180
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Fax | 301-631-1299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | D73728
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | MD447117
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License Number State | PA
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