Healthcare Provider Details

I. General information

NPI: 1235116062
Provider Name (Legal Business Name): KEITH J WROBLEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FT MEADE MD
20755-5800
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2800
  • Fax:
Mailing address:
  • Phone: 301-677-8124
  • Fax: 301-677-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD59403
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD044144
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: