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General NPI Number Information
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NPI Number | 1710085303
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Entity Type | Individual
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Provider Name | JACK ELLIOT ROSENBLATT MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 7000 CARMICHAEL AVE
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City | BETHESDA
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State | MD
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Zip | 20817-4612
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Country | US
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Telephone | 301-873-7904
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Fax | 301-320-0856
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Provider Business Mailing Address
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Address Line | 7000 CARMICHAEL AVE
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City | BETHESDA
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State | MD
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Zip | 20817-4612
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Country | US
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Telephone | 301-873-7904
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Fax | 301-320-0856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | D0018209
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D18209
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License Number State | MD
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