Individual
MOLLY D BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2002 MEDICAL PKWY, SUITE 460, ANNAPOLIS, MD 21401-3046
(410) 266-2725
(410) 224-6793
Mailing address
PO BOX 64584, BALTIMORE, MD 21264-4584
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0003022
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165783ZEZT
MEDICARE PTAN
MD
Enumeration date
06/13/2006
Last updated
11/04/2009
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