Provider Demographics
NPI:1194005512
Name:HUNT VALLEY URGENT CARE
Entity Type:Organization
Organization Name:HUNT VALLEY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROADWATER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-628-2140
Mailing Address - Street 1:10 WARREN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2506
Mailing Address - Country:US
Mailing Address - Phone:410-628-2140
Mailing Address - Fax:410-667-4703
Practice Address - Street 1:10 WARREN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2506
Practice Address - Country:US
Practice Address - Phone:410-628-2140
Practice Address - Fax:410-667-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD15200261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD75251Medicare UPIN