Healthcare Provider Details

I. General information

NPI: 1144685207
Provider Name (Legal Business Name): ROBERT ROTENBERG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10084 REISTERSTOWN RD STE 200A
OWINGS MILLS MD
21117-4096
US

IV. Provider business mailing address

611 S CHARLES ST UNIT 323
BALTIMORE MD
21230-3881
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-5050
  • Fax: 410-552-0200
Mailing address:
  • Phone: 303-921-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: