Healthcare Provider Details

I. General information

NPI: 1114993078
Provider Name (Legal Business Name): ROSS E TAUBMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 DAYLONG LN SUITE 102
CLARKSVILLE MD
21029-1626
US

IV. Provider business mailing address

6100 DAYLONG LN SUITE 102
CLARKSVILLE MD
21029-1626
US

V. Phone/Fax

Practice location:
  • Phone: 443-535-8770
  • Fax: 443-535-8775
Mailing address:
  • Phone: 443-535-8770
  • Fax: 443-535-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: