Provider Demographics
NPI:1578510202
Name:TATTELBAUM, ADAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:G
Last Name:TATTELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9517 ACCORD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4302
Mailing Address - Country:US
Mailing Address - Phone:301-656-6398
Mailing Address - Fax:
Practice Address - Street 1:3203 TOWER OAKS BLVD
Practice Address - Street 2:#200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4258
Practice Address - Country:US
Practice Address - Phone:301-656-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053872208200000X
DCMD20198208200000X
MA80944208200000X
MDD0045135208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty