Healthcare Provider Details

I. General information

NPI: 1578510202
Provider Name (Legal Business Name): ADAM G TATTELBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 TOWER OAKS BLVD #200
ROCKVILLE MD
20852-4258
US

IV. Provider business mailing address

9517 ACCORD DR
POTOMAC MD
20854-4302
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6398
  • Fax:
Mailing address:
  • Phone: 301-656-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101053872
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD20198
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number80944
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0045135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: