Healthcare Provider Details

I. General information

NPI: 1760577126
Provider Name (Legal Business Name): MARTIN STEVEN RUSINOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE BLDG. 22 RM.4345
SILVER SPRING MD
20903-1058
US

IV. Provider business mailing address

10903 NEW HAMPSHIRE AVE BLDG. 22 RM.4345
SILVER SPRING MD
20903-1058
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-0158
  • Fax: 301-796-9842
Mailing address:
  • Phone: 301-796-0158
  • Fax: 301-796-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0033584
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: