Provider Demographics
NPI:1164590147
Name:TANENBAUM, BRUCE LEE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE M
Last Name:TANENBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7945 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7945 MACARTHUR BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1634
Practice Address - Country:US
Practice Address - Phone:301-320-3701
Practice Address - Fax:301-320-3742
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00196802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM53652OtherCONTROLLED SUBSTANCE
MDD0019680OtherBOARD OF PHYSICIANS
MDD0019680OtherBOARD OF PHYSICIANS