Healthcare Provider Details

I. General information

NPI: 1295928026
Provider Name (Legal Business Name): BRUCE S ROSENBLUM, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY CENTURY PLAZA 1000, 317
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY CENTURY PLAZA 1000, 317
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-0774
  • Fax: 410-772-0776
Mailing address:
  • Phone: 410-772-0774
  • Fax: 410-772-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0029739
License Number StateMD

VIII. Authorized Official

Name: DR. BRUCE ROSENBLUM
Title or Position: PRESIDENT
Credential: MD
Phone: 410-772-0774