Provider Demographics
NPI:1053343863
Name:BROSCH, FAITH A, (MD,)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:A,
Last Name:BROSCH
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:A,
Other - Last Name:GALELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP1, SUITE 207
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-9000
Mailing Address - Fax:302-368-9004
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:MAP1, SUITE 207
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-9000
Practice Address - Fax:302-368-9004
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000318401Medicaid
664554M82Medicare ID - Type Unspecified
E79582Medicare UPIN