Provider Demographics
NPI:1326420589
Name:TROPHOGEN, INC.
Entity Type:Organization
Organization Name:TROPHOGEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO & CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-838-1935
Mailing Address - Street 1:9714 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 1114
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3773
Mailing Address - Country:US
Mailing Address - Phone:301-838-1935
Mailing Address - Fax:301-762-6287
Practice Address - Street 1:9714 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 1114
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3773
Practice Address - Country:US
Practice Address - Phone:301-838-1935
Practice Address - Fax:301-762-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34879207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty