1457384950 NPI number — DR. ROBERTA BRAUN M.D.

Table of content: DR. ROBERTA BRAUN M.D. (NPI 1457384950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457384950 NPI number — DR. ROBERTA BRAUN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAUN
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457384950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GOOSE HILL MANOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21666-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-643-2086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2629 RIVA RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-1000
Provider Business Practice Location Address Fax Number:
410-573-4028
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D0025928 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 281928 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9991 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5022162 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003 . This is a "CAREFIRST DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110115 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1979771 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4084092001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41127602 . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2310518 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700246 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 039592 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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