Healthcare Provider Details

I. General information

NPI: 1801820964
Provider Name (Legal Business Name): ROBERT JAY GINSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 NATIONAL DRIVE SUITE 220
BURTONSVILLE MD
20866-6106
US

IV. Provider business mailing address

3905 NATIONAL DRIVE SUITE 220
BURTONSVILLE MD
20866-6106
US

V. Phone/Fax

Practice location:
  • Phone: 240-389-1192
  • Fax: 240-389-1186
Mailing address:
  • Phone: 240-389-1192
  • Fax: 240-389-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD25344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: