Provider Demographics
NPI:1750616645
Name:BROADNAX, MICHELLE ALETA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ALETA
Last Name:BROADNAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9705 POLING TER
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3970
Mailing Address - Country:US
Mailing Address - Phone:301-248-8238
Mailing Address - Fax:
Practice Address - Street 1:1313 NEW YORK AVE NW
Practice Address - Street 2:MCCLENDON CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4701
Practice Address - Country:US
Practice Address - Phone:202-737-2316
Practice Address - Fax:202-737-2316
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD179922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry