MEDICARE: MR. BARRY N ROSENBAUM MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	D0009834	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C066-0001	OTHER	DC	BCBS NCA

General Provider Information

NPI Number	:	1427049436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY N ROSENBAUM MD

Provider Business Mailing Address
First Line	:	2ND FLOOR
Second Line	:	3720 FARRAGUT AVENUE
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-949-4242
Fax Number	:	301-949-8041

Provider Business Practice Location Address
First Line	:	2ND FLOOR
Second Line	:	3720 FARRAGUT AVENUE
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-949-4242
Fax Number	:	301-949-8041

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/03/2007

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