Provider Demographics
NPI:1356817001
Name:BROADNAX, RASHAN J'MAL
Entity Type:Individual
Prefix:DR
First Name:RASHAN
Middle Name:J'MAL
Last Name:BROADNAX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 FLORIDA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3024
Mailing Address - Country:US
Mailing Address - Phone:202-321-3046
Mailing Address - Fax:
Practice Address - Street 1:705 FLORIDA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3024
Practice Address - Country:US
Practice Address - Phone:202-321-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management