Provider Demographics
NPI:1922327022
Name:BRADEN, MARY MILLER (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MILLER
Last Name:BRADEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:410-384-9311
Mailing Address - Fax:410-384-9433
Practice Address - Street 1:995 PRINCE FREDERICK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-5101
Practice Address - Country:US
Practice Address - Phone:443-351-3376
Practice Address - Fax:410-535-6574
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251076207N00000X
MDD89039207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology