1407846769 NPI number — RODNEY E. GROLMAN, M.D., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407846769 NPI number — RODNEY E. GROLMAN, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODNEY E. GROLMAN, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407846769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CHARLES PLZ
Provider Second Line Business Mailing Address:
APT 2704
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-4238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-368-2700
Provider Business Mailing Address Fax Number:
410-368-3569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 BENSON AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-368-2700
Provider Business Practice Location Address Fax Number:
410-368-3569
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GROLMAN
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
EDMIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-368-2700

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  D0060134 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 62011001 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K1550001 . This is a "BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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