MEDICARE: GERALD ROTTMAN 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	208D00000X	General Practice Physician	D0050313	MD

General Provider Information

NPI Number	:	1902037328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD ROTTMAN M.D.

Provider Business Mailing Address
First Line	:	6905 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-1607
Country	:	US
Telephone Number	:	410-358-5427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6905 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-1607
Country	:	US
Telephone Number	:	410-358-5427
Fax Number	:

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

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	08/03/2009

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