Provider Demographics
NPI:1215041728
Name:BETTY TOLORIA BRASWELL, MD, PC
Entity Type:Organization
Organization Name:BETTY TOLORIA BRASWELL, MD, PC
Other - Org Name:SUNSET FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:B TOLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-568-3333
Mailing Address - Street 1:5111 SILVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5216
Mailing Address - Country:US
Mailing Address - Phone:301-568-3333
Mailing Address - Fax:
Practice Address - Street 1:5111 SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-5216
Practice Address - Country:US
Practice Address - Phone:301-568-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB21472Medicare UPIN