Ronald Lee Broadwater Sr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0015200 Issued in MD

Practice address

12 Brecon PL
Ste 400
Cockeysville, MD 21030-2343

Phone

(443) 281-8086

Fax

(443) 281-8117

NPI assigned

Sep 20, 2006

Last updated

Mar 6, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hunt Valley Urgent Care

  • Urgent Care Clinic/Center
  • Cockeysville, MD
  • NPI 1194005512
  NPD (past) Authorized official
• Ronald L. Broadwater Sr. M.D.PA

  • Primary Care Clinic/Center
  • Cockeysville, MD
  • NPI 1497051395
  Authorized official Same address or phone
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394064000000",
    "number": "1821196601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BRECON PL",
            "address_2": "STE 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": "STE 400",
            "city": "COCKEYSVILLE",
            "state": "MD",
            "postal_code": "210302343",
            "telephone_number": "443-281-8086",
            "fax_number": "443-281-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "RONALD",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0015200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridge Home Heath Care, Inc
• Shenaya A Bright, LMSW
• Brightview Hunt Valley, LLC (Brightview Hunt Valley)
• Broadmead Medical Services, Inc
• Broadmead, Inc
• Elyse Buchbinder, MS, CNS, LDN
• Sara G Buck, LCSW-C
• Tanya Buettnerstemple
• Building Resilience Mental Health Services, LLC
• Jennifer Lynn Bull, CRNP

• Family Medicine Physician in Cockeysville, MD
• Providers in Cockeysville, MD by specialty
• Family Medicine Physician 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.