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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

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