Healthcare Provider Details

I. General information

NPI: 1336286855
Provider Name (Legal Business Name): BARRY N ROSENBAUM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2ND FLOOR 3720 FARRAGUT AVENUE
KENSINGTON MD
20895-2110
US

IV. Provider business mailing address

2ND FLOOR 3720 FARRAGUT AVENUE
KENSINGTON MD
20895-2110
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-8013
  • Fax: 301-949-8041
Mailing address:
  • Phone: 301-949-8013
  • Fax: 301-949-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD09834
License Number StateMD

VIII. Authorized Official

Name: PATRICIA ARELLANO
Title or Position: OFC/BILLING MGR
Credential:
Phone: 301-949-8013