Provider Demographics
NPI:1194967091
Name:BRAUNSTEIN, EVAN MARK (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MARK
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6421
Mailing Address - Fax:410-955-8587
Practice Address - Street 1:401 NORTH BROADWAY
Practice Address - Street 2:ROOM 1363
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1146
Practice Address - Country:US
Practice Address - Phone:410-955-8893
Practice Address - Fax:410-955-8587
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72008207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD72008OtherLICENSE