Healthcare Provider Details

I. General information

NPI: 1548387327
Provider Name (Legal Business Name): MARTIN R SCHWARTZBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 OLD COURT RD SUITE 201
BALTIMORE MD
21208-4038
US

IV. Provider business mailing address

106 OLD COURT RD SUITE 201
BALTIMORE MD
21208-4038
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-1133
  • Fax: 410-486-9451
Mailing address:
  • Phone: 410-486-1133
  • Fax: 410-486-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12152
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: