1336286855 NPI number — BARRY N ROSENBAUM MD PA

Table of content: (NPI 1336286855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336286855 NPI number — BARRY N ROSENBAUM MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY N ROSENBAUM MD PA
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:
6
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:
1336286855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2ND FLOOR
Provider Second Line Business Mailing Address:
3720 FARRAGUT AVENUE
Provider Business Mailing Address City Name:
KENSINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20895-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-949-8013
Provider Business Mailing Address Fax Number:
301-949-8041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2ND FLOOR
Provider Second Line Business Practice Location Address:
3720 FARRAGUT AVENUE
Provider Business Practice Location Address City Name:
KENSINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20895-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-949-8013
Provider Business Practice Location Address Fax Number:
301-949-8041
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARELLANO
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFC/BILLING MGR
Authorized Official Telephone Number:
301-949-8013

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  D09834 , 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: 911221900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: C066 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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