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General NPI Number Information
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NPI Number | 1699736900
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Entity Type | Individual
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Provider Name | RANDALL BROCKMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9200 CORPORATE BLVD HFZ-450
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City | ROCKVILLE
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State | MD
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Zip | 20850-3229
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Country | US
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Telephone | 301-443-8517
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Fax | 301-594-3076
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Provider Business Mailing Address
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Address Line | 8129 MORNING BREEZE DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6476
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Country | US
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Telephone |
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | D0050594
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License Number State | MD
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