Provider Demographics
NPI:1225052228
Name:ROSENBLUM, BRUCE STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:STANLEY
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:CENTURY PLAZA 1000, 317
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3264
Mailing Address - Country:US
Mailing Address - Phone:410-772-0774
Mailing Address - Fax:410-772-0776
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:CENTURY PLAZA 1000, 317
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3264
Practice Address - Country:US
Practice Address - Phone:410-772-0774
Practice Address - Fax:410-772-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00297392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD253P531GMedicare UPIN