Provider Demographics
NPI:1568685253
Name:BROADWATER, RALPH PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:PATRICK
Last Name:BROADWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 HOSPITAL ROAD
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264
Mailing Address - Country:US
Mailing Address - Phone:603-536-1120
Mailing Address - Fax:603-536-4828
Practice Address - Street 1:16 HOSPITAL ROAD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:603-536-1120
Practice Address - Fax:603-536-4828
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH8114207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE0134Medicare ID - Type Unspecified
NHE12435Medicare UPIN