=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922240332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A ROUTENBERG MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2009
-----------------------------------------------------
Last Update Date | 03/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 S DIVISION ST
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-4930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-543-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 OMEGA DR BUILDING D
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-2063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-283-3300
-----------------------------------------------------
Fax | 302-283-3321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN ROUTENBERG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-543-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | D15857
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------