Healthcare Provider Details

I. General information

NPI: 1124088109
Provider Name (Legal Business Name): ALFRED B ROSENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD SUITE 205
BALTIMORE MD
21208-2800
US

IV. Provider business mailing address

4000 OLD COURT RD SUITE 205
BALTIMORE MD
21208-2800
US

V. Phone/Fax

Practice location:
  • Phone: 410-655-4600
  • Fax: 410-484-7541
Mailing address:
  • Phone: 410-655-4600
  • Fax: 410-484-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD10148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: