Provider Demographics
NPI:1508854555
Name:BROTH, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:BROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10801 LOCKWOOD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-681-0004
Mailing Address - Fax:512-532-0871
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-681-0004
Practice Address - Fax:512-532-0871
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0064574207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158004060OtherMARYLAND PHYSICIANS CARE MCO
MD268283OtherKAISER
MD7400548OtherAMERICHOICE
MD889124OtherBCBS MARYLAND
MD208515OtherPRIORITY PARTNERS (JOHN HOPKINS HEALTH PLAN)
MD7850486OtherAETNA HMO
MD7850486OtherAETNA NON HMO
DC0003OtherBCBS NCA
MD308439OtherAMERIGROUP
MD872173OtherFIRST HEALTH/COVENTRY
MD9304733OtherPHCS
MD7156605OtherCIGNA
MD771360OtherNCPPO
MD411254700Medicaid
MD2163864OtherUNITED HEALTHCARE
MDI21107Medicare UPIN