Healthcare Provider Details

I. General information

NPI: 1457341430
Provider Name (Legal Business Name): SAMUEL M ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 MEDICAL CENTER DR STE 212
ROCKVILLE MD
20850-3323
US

IV. Provider business mailing address

PO BOX 744785
ATLANTA GA
30374-4785
US

V. Phone/Fax

Practice location:
  • Phone: 301-738-7011
  • Fax: 301-340-9136
Mailing address:
  • Phone: 22-476-5000
  • Fax: 301-340-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberD0045727
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: