MEDICARE: RICHARD E BROTH M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	D0064574	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	158004060	OTHER	MD	MARYLAND PHYSICIANS CARE MCO
2	268283	OTHER	MD	KAISER
3	7400548	OTHER	MD	AMERICHOICE
4	889124	OTHER	MD	BCBS MARYLAND
5	208515	OTHER	MD	PRIORITY PARTNERS (JOHN HOPKINS HEALTH PLAN)
6	7850486	OTHER	MD	AETNA HMO
7	7850486	OTHER	MD	AETNA NON HMO
8	0003	OTHER	DC	BCBS NCA
9	308439	OTHER	MD	AMERIGROUP
10	872173	OTHER	MD	FIRST HEALTH/COVENTRY
11	9304733	OTHER	MD	PHCS
12	7156605	OTHER	MD	CIGNA
13	771360	OTHER	MD	NCPPO
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	2163864	OTHER	MD	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1508854555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E BROTH M.D

Provider Business Mailing Address
First Line	:	10801 LOCKWOOD DR
Second Line	:	SUITE 300
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1556
Country	:	US
Telephone Number	:	301-681-0004
Fax Number	:	512-532-0871

Provider Business Practice Location Address
First Line	:	10801 LOCKWOOD DR
Second Line	:	SUITE 300
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1556
Country	:	US
Telephone Number	:	301-681-0004
Fax Number	:	512-532-0871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	03/28/2011

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Practice Location Address:

10801 LOCKWOOD DR
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20901-1556

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Practice Fax:

1770580607 — DR. BARRY MICHAEL RUBIN M.D.
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1477534063 — CHARLES KENNETH TRAVERS MD
Practice Location Address:

10801 LOCKWOOD DR , STE 320
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20901-1556

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1730161522 — JESSICA BERGER-WEISS MD
Practice Location Address:

10801 LOCKWOOD DR , STE 320
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20901-1556

Practice Phone: 301-681-3400
Practice Fax: 301-681-7982

1275510257 — DR. MILTON KOCH M.D.
Practice Location Address:

10801 LOCKWOOD DR
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20901-1556

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1366415077 — DR. KATHLEEN M KADOW M.D., M.P.H.
Practice Location Address:

10801 LOCKWOOD DR , SUITE 325
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Directions to “ RICHARD E BROTH M.D” Practice Location

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