MEDICARE: BRUCE STANLEY ROSENBLUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D0029739	MD

General Provider Information

NPI Number	:	1225052228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE STANLEY ROSENBLUM M.D.

Provider Business Mailing Address
First Line	:	10630 LITTLE PATUXENT PKWY
Second Line	:	CENTURY PLAZA 1000, 317
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3264
Country	:	US
Telephone Number	:	410-772-0774
Fax Number	:	410-772-0776

Provider Business Practice Location Address
First Line	:	10630 LITTLE PATUXENT PKWY
Second Line	:	CENTURY PLAZA 1000, 317
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3264
Country	:	US
Telephone Number	:	410-772-0774
Fax Number	:	410-772-0776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/21/2008

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