Healthcare Provider Details

I. General information

NPI: 1720146624
Provider Name (Legal Business Name): BARBARA B ROSENBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVENUE
KANSINGTON MD
20895-2138
US

IV. Provider business mailing address

10500 SUMMIT AVENUE
KENSINGTON MD
20895-2422
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2325
  • Fax: 301-897-2333
Mailing address:
  • Phone: 301-897-2325
  • Fax: 310-897-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD59725
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD33138
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: