MOLLY D BROCKETT (NPI# 1295778983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295778983 |
| Entity Type | Individual |
| Full Name | MOLLY D BROCKETT |
| Credential | PA-C |
| Practice Address |
2002 Medical Pkwy Suite 460 Annapolis MD 21401-3046 |
| Mailing Address |
Po Box 64584 Baltimore MD 21264-4584 |
| Practice Telephone | 4102662725 |
| Practice Fax Number | 4102246793 |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2009-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | C0003022 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | MEDICARE PTAN | 165783ZEZT | 01 |
| Street Address |
2002 MEDICAL PKWY SUITE 460 |
| City | ANNAPOLIS |
| State | MD |
| Zip Code | 21401-3046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366448953 | Ayanna L James | Obstetrics & Gynecology | 2002 Medical Pkwy, Suite 635, Annapolis, MD 21401-3046 | 2005-06-28 |
| 1336611466 | Lauren Mason | Social Worker | 2002 Medical Pkwy, Annapolis, MD 21401-3046 | 2018-12-31 |
| 1184131542 | Amanda Nicole Minnitte | Physical Therapy Assistant | 2002 Medical Pkwy, Annapolis, MD 21401-3046 | 2018-01-08 |
| 1255878526 | Maryland Medicinal LLC | Physical Medicine & Rehabilitation | 2002 Medical Pkwy, Suite 150, Annapolis, MD 21401-3046 | 2017-01-25 |
| 1669917993 | Back To Fit Inc. | Physical Medicine & Rehabilitation | 2002 Medical Pkwy, 150, Annapolis, MD 21401-3046 | 2016-12-22 |
| 1821549528 | Anne Arundel Physician Group, LLC | Family Medicine | 2002 Medical Pkwy, Suite 460, Annapolis, MD 21401-3046 | 2016-10-18 |
| 1114372497 | Anne Arundel Physician Group, LLC | Clinical Neuropsychologist | 2002 Medical Pkwy, Suite 430, Annapolis, MD 21401-3046 | 2016-04-25 |
| 1487040036 | Gaurav Srivastava | Ophthalmology | 2002 Medical Pkwy, Annapolis, MD 21401-3046 | 2015-04-10 |
| 1164828679 | Med-park LLC | Pharmacy | 2002 Medical Pkwy, Ste 170, Annapolis, MD 21401-3046 | 2014-11-10 |
| 1992147631 | Zachary Scott La Fratta | Audiologist | 2002 Medical Pkwy, Suite 230 Sajak Building, Annapolis, MD 21401-3046 | 2013-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497377154 | Michael Khorsandi | Student in an Organized Health Care Education/Training Program | 2001 Medical Parkway, Clatanoff Pavillon, Gmw Office, Annapolis, MD 21401 | 2020-05-15 |
| 1275172033 | Katrice N Nelson | Massage Therapist | Wellsview Cottage Center, 613 Ridgely Avenue, Annapolis, MD 21401 | 2019-12-27 |
| 1548803521 | Victoria Reimnitz | Behavioral Analyst | 2028 Indusrtrial Dr, Ste B&c, Annapolis, MD 21401 | 2019-10-23 |
| 1700438140 | Emily Megan Burke | Nurse Practitioner | 200 Forbes St Annapolis, Md 21401, Suite 200, Annapolis, MD 21401 | 2019-07-16 |
| 1316504848 | Sherina Maryam Shamsa | Counselor | 1830 Forest Drive, Suite H-2, Annapolis, MD 21401 | 2019-05-21 |
| 1497225288 | Jerilyn Deitch | Speech-Language Pathologist | Anne Arundel County Public Schools, 2644 Riva Rd, Annapolis, MD 21401 | 2018-12-05 |
| 1487124038 | Lucinda W Mimms | Speech-Language Pathologist | 2644 Riva Rd., Annapolis, MD 21401 | 2018-11-27 |
| 1487145496 | Michelle Baudean | Behavior Technician | 1919 West St Ste 201, Annapolis, MD 21401 | 2018-05-24 |
| 1730678954 | Stephanie Ruth Streb | Registered Nurse | 130 Admiral Cochrane Dr Ste 103, Annapolis, MD 21401 | 2018-05-02 |
| 1780183947 | Annapolis Sleep Center LLC | Clinic/Center | 2451 Riva Rd, Annapolis, MD 21401 | 2018-02-02 |
| Find all providers in zip 21401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689140436 | Rachel M Ostrow | Physician Assistant | 527 Lee Cir, Annapolis, MD 21403-4012 | 2018-10-19 |
| 1285100446 | Georgia L Harper | Physician Assistant | 201 Defense Hwy Ste 205, Annapolis, MD 21401-7096 | 2018-10-15 |
| 1316422561 | Colin Patrick Rainey | Physician Assistant | 122 Defense Hwy Ste 210, Annapolis, MD 21401-7071 | 2018-10-03 |
| 1679977078 | Caroline Jill Buehler | Physician Assistant | 2002 Medical Parkway,, Annapolis Dermatology Associates, Suite 630, Annapolis, MD 21401 | 2014-10-14 |
| 1447682828 | Janette Marie Roderick Sauter | Physician Assistant | 166 Defense Hwy Ste 302, Annapolis, MD 21401-8926 | 2013-08-07 |
| 1184809998 | Ann Marie Lawson | Physician Assistant | 703 Giddings Ave., Suite M, Annapolis, MD 21401-1437 | 2007-12-31 |
| 1619194701 | Marie Darcy Goodman | Physician Assistant | 193 Green Street, Annapolis, MD 21401 | 2007-04-19 |
| 1407805393 | Suzanne Shelling | Physician Assistant | 2002 Medical Pkwy Ste 235, Annapolis, MD 21401-3260 | 2006-05-08 |
| 1184602724 | Kim S. Endres | Physician Assistant | 2002 Medical Pkwy Ste 430, Annapolis, MD 21401-3263 | 2006-01-04 |
| 1740275148 | Maureen L O'brien | Physician Assistant | 2000 Medical Parkway, Suite 200, Annapolis, MD 21401-3744 | 2005-09-13 |
| Find all providers in ANNAPOLIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.