Healthcare Provider Details

I. General information

NPI: 1003809310
Provider Name (Legal Business Name): MARK ROSENBLUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR STE 503
BETHESDA MD
20817-7822
US

IV. Provider business mailing address

25 CROSSROADS DR STE 306
OWINGS MILLS MD
21117-5437
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1700
  • Fax:
Mailing address:
  • Phone: 443-738-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD035492
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0063348
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101287326
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: