MEDICARE: DR. JASON GABRIEL BROMER 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	207VE0102X	Reproductive Endocrinology Physician	D73728	MD
2	207VE0102X	Reproductive Endocrinology Physician	MD447117	PA

General Provider Information

NPI Number	:	1619997491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON GABRIEL BROMER M.D.

Provider Business Mailing Address
First Line	:	45 THOMAS JOHNSON DR
Second Line	:	SUITE 107
City	:	FREDERICK
State	:	MD
Zip	:	21702-4425
Country	:	US
Telephone Number	:	301-631-1180
Fax Number	:	301-631-1299

Provider Business Practice Location Address
First Line	:	45 THOMAS JOHNSON DR
Second Line	:	SUITE 107
City	:	FREDERICK
State	:	MD
Zip	:	21702-4425
Country	:	US
Telephone Number	:	301-631-1180
Fax Number	:	301-631-1299

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/03/2013

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