Provider Demographics
NPI:1700112414
Name:BROZGAL, RUTH
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:BROZGAL
Suffix:
Gender:F
Credentials:
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 1405
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-1405
Mailing Address - Country:US
Mailing Address - Phone:240-550-0983
Mailing Address - Fax:
Practice Address - Street 1:250 PRESIDENT ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4436
Practice Address - Country:US
Practice Address - Phone:443-320-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist