Provider Demographics
NPI:1124063557
Name:BROCKENBROUGH, EDWIN CHAMBERLAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CHAMBERLAYNE
Last Name:BROCKENBROUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3630 HUNTS POINT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTS POINT
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1114
Mailing Address - Country:US
Mailing Address - Phone:425-454-6432
Mailing Address - Fax:425-454-0205
Practice Address - Street 1:3630 HUNTS POINT RD
Practice Address - Street 2:
Practice Address - City:HUNTS POINT
Practice Address - State:WA
Practice Address - Zip Code:98004-1114
Practice Address - Country:US
Practice Address - Phone:425-454-6432
Practice Address - Fax:425-454-0205
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA89672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery