Provider Demographics
NPI:1265829477
Name:ROTBERG, DAVID ELIJAH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ELIJAH
Last Name:ROTBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:667-214-1616
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:667-214-1616
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087093207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology