Healthcare Provider Details

I. General information

NPI: 1154852317
Provider Name (Legal Business Name): LAUREN ROSENBLATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S. PACA STREET 6TH FLOOR, SUITE 200
BALTIMORE MD
21201
US

IV. Provider business mailing address

110 S. PACA STREET 6TH FLOOR, SUITE 200
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8025
  • Fax:
Mailing address:
  • Phone: 410-328-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number111135
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number111135
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0089009
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: