Provider Demographics
NPI:1578214110
Name:BROHAWN, CAROLINE (LAC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BROHAWN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 BONNIE RIDGE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-5169
Mailing Address - Country:US
Mailing Address - Phone:301-802-4264
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD STE 207
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3107
Practice Address - Country:US
Practice Address - Phone:410-296-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02877171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist