=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659424240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID A BROYLES DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MARIS GROVE WAY
-----------------------------------------------------
City | GLEN MILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19342-1282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-387-4520
-----------------------------------------------------
Fax | 610-387-4526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 EXECUTIVE DR STE 230
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-387-4520
-----------------------------------------------------
Fax | 610-387-4526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C2-0024846
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS009850L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------