Basic Information
Provider Information
NPI: 1588831747
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUBAKER
FirstName: KAREN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 418283
Address2:  
City: BOSTON
State: MA
PostalCode: 022418283
CountryCode: US
TelephoneNumber: 3018688000
FaxNumber:  
Practice Location
Address1: 7503 SURRATTS RD
Address2:  
City: CLINTON
State: MD
PostalCode: 207353358
CountryCode: US
TelephoneNumber: 3018688000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/15/2008
LastUpdateDate: 07/02/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD455847PAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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