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Ms. Cynthia Denise Broadnax
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NPI Number Detailed Information
Provider Information:
| Name: | Ms. Cynthia Denise Broadnax |
| Gender: | F |
| Provider License Number If Given: | R125951 |
NPI Information:
| NPI: | 1710971221 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 2/17/2009 |
Provider Business Mailing Address:
| Address: | 8636 SIDE SADDLE CT Randallstown, MD 21133 |
| Phone Number: | 4105818638 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 1001 YORK RD Towson, MD 21204 |
| Phone Number: | 8663892727 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 363LF0000X |
| Secondary (if any): | |
| State: | MD |
