Provider Demographics
NPI:1407846769
Name:RODNEY E. GROLMAN, M.D., P.A.
Entity Type:Organization
Organization Name:RODNEY E. GROLMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:EDMIN
Authorized Official - Last Name:GROLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-368-2700
Mailing Address - Street 1:8 CHARLES PLZ
Mailing Address - Street 2:APT 2704
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4238
Mailing Address - Country:US
Mailing Address - Phone:410-368-2700
Mailing Address - Fax:410-368-3569
Practice Address - Street 1:3421 BENSON AVE
Practice Address - Street 2:STE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1056
Practice Address - Country:US
Practice Address - Phone:410-368-2700
Practice Address - Fax:410-368-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060134208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62011001OtherBLUE SHIELD
DCK1550001OtherBLUE SHIELD
MD62011001OtherBLUE SHIELD
DCK1550001OtherBLUE SHIELD