Provider Demographics
NPI:1679628291
Name:ROSENER, DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ROSENER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 DEEPAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5219
Mailing Address - Country:US
Mailing Address - Phone:410-381-7000
Mailing Address - Fax:410-381-3779
Practice Address - Street 1:7080 DEEPAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5219
Practice Address - Country:US
Practice Address - Phone:410-381-7000
Practice Address - Fax:410-381-3779
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS429OtherBLUE SHIELD DC
MDKBX3OtherBLUE SHIELD MD
MDS429OtherBLUE SHIELD DC