Provider Demographics
NPI:1437491446
Name:BROMBERG, NANCY MAXINE (VMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MAXINE
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4604
Mailing Address - Country:US
Mailing Address - Phone:703-752-9100
Mailing Address - Fax:703-752-9207
Practice Address - Street 1:8500 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4604
Practice Address - Country:US
Practice Address - Phone:703-752-9100
Practice Address - Fax:703-752-9207
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0301002352174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian