Provider Demographics
NPI:1962630624
Name:BROUGHEL-BAER, DARCY ERIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:ERIN
Last Name:BROUGHEL-BAER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRADHURST AVE
Mailing Address - Street 2:APT 1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3305
Mailing Address - Country:US
Mailing Address - Phone:347-726-8738
Mailing Address - Fax:
Practice Address - Street 1:102 BRADHURST AVE
Practice Address - Street 2:APT 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3305
Practice Address - Country:US
Practice Address - Phone:347-726-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252204207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology