Provider Demographics
NPI:1164423190
Name:STROMBERG, MARK REMSON (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:REMSON
Last Name:STROMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:STROMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6701 N CHARLES ST
Mailing Address - Street 2:STE 4106
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-828-0905
Mailing Address - Fax:410-825-0675
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:STE 4106
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-828-0905
Practice Address - Fax:410-825-0675
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8208Medicare ID - Type Unspecified
B69781Medicare UPIN