Provider Demographics
NPI:1760692313
Name:BROACH, AMY NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:BROACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX OFFICE
Mailing Address - Street 2:BOX 3609
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-660-2370
Mailing Address - Fax:919-660-2370
Practice Address - Street 1:PO BOX OFFICE
Practice Address - Street 2:BOX 3609
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-660-2370
Practice Address - Fax:919-660-2370
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427525207V00000X
NC2008-01474207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology