Provider Demographics
NPI:1336029776
Name:BROADNAX, BARRY JR
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BROADNAX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 GRESHAM PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20059-1010
Mailing Address - Country:US
Mailing Address - Phone:276-806-5971
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW STE 4200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2972
Practice Address - Country:US
Practice Address - Phone:202-877-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program