Ronald L. Broadwater Sr. M.D.PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

D15200 Issued in MD

Legal business name

RONALD L. BROADWATER SR. M.D.PA

Practice address

12 Brecon PL
Suite 400
Cockeysville, MD 21030-2343

Phone

(443) 281-8086

Fax

(443) 281-8117

NPI assigned

Feb 10, 2011

Last updated

Mar 6, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ronald Lee Broadwater Sr., M.D.NPI 1821196601

Title

Owner/Medical Provider

Phone

(443) 281-8086

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronald Lee Broadwater Sr., MD

  • Family Medicine Physician
  • Cockeysville, MD
  • NPI 1821196601
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1497051395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BRECON PL",
            "address_2": "SUITE 400",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210302343",
            "telephone_number": "443-281-8086",
            "fax_number": "443-281-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BRECON PL",
            "address_2": "SUITE 400",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210302343",
            "telephone_number": "443-281-8086",
            "fax_number": "443-281-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD L. BROADWATER SR. M.D.PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-10",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "BROADWATER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/MEDICAL PROVIDER",
        "authorized_official_telephone_number": "443-281-8086",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D15200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Cockeysville, MD
• Providers in Cockeysville, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.