Provider Demographics
NPI:1376583864
Name:GARTENHAUS, RONALD BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BENJAMIN
Last Name:GARTENHAUS
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 62602
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:410-328-2567
Mailing Address - Fax:410-328-6559
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2567
Practice Address - Fax:410-328-6559
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62351207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037569800Medicaid
MD644466-01OtherBLUE CROSS/BLUE SHIELD
MD406206000Medicaid
MD644466-01OtherBLUE CROSS/BLUE SHIELD
MDK200Medicare PIN
F44450Medicare UPIN