Individual
MR. RONALD LEE BROADWATER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 BRECON PL, STE 400, COCKEYSVILLE, MD 21030-2343
(443) 281-8086
(443) 281-8117
Mailing address
12 BRECON PL, STE 400, COCKEYSVILLE, MD 21030-2343
(443) 281-8086
(443) 281-8117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0015200
MD
Other
Enumeration date
09/20/2006
Last updated
03/06/2014
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