Organization
RONALD L. BROADWATER SR. M.D.PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD LEE BROADWATER SR. M.D. (OWNER/MEDICAL PROVIDER)
(443) 281-8086
Entity
Organization
Contact information
Practice address
12 BRECON PL, SUITE 400, COCKEYSVILLE, MD 21030-2343
(443) 281-8086
(443) 281-8117
Mailing address
12 BRECON PL, SUITE 400, COCKEYSVILLE, MD 21030-2343
(443) 281-8086
(443) 281-8117
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D15200
MD
Other
Enumeration date
02/10/2011
Last updated
03/06/2014
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