Provider Demographics
NPI:1457384950
Name:BRAUN, ROBERTA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:BRAUN
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 1:200 GOOSE HILL MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3041
Mailing Address - Country:US
Mailing Address - Phone:410-643-2086
Mailing Address - Fax:
Practice Address - Street 1:2629 RIVA RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7428
Practice Address - Country:US
Practice Address - Phone:410-266-1000
Practice Address - Fax:410-573-4028
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025928208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
281928OtherMAMSI
9991OtherKAISER
5022162OtherAETNA PPO
MD0003OtherCAREFIRST DC
110115OtherCOVENTRY
1979771OtherUNITED HEALTHCARE
4084092001OtherCIGNA
MD41127602OtherCAREFIRST MARYLAND
2310518OtherAETNA HMO
700246OtherNCPPO
MD039592OtherJOHNS HOPKINS HEALTHCARE
4084092001OtherCIGNA
X951Medicare ID - Type Unspecified
700246OtherNCPPO