Provider Demographics
NPI:1730122128
Name:ROSENBLUM, NATHAN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MARK
Last Name:ROSENBLUM
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 25
Mailing Address - Street 2:8016 BELLONA AVE
Mailing Address - City:RIDERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21137
Mailing Address - Country:US
Mailing Address - Phone:410-825-2470
Mailing Address - Fax:410-825-5138
Practice Address - Street 1:5 WINDBLOWN CT
Practice Address - Street 2:APT 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207
Practice Address - Country:US
Practice Address - Phone:410-456-6864
Practice Address - Fax:410-825-5138
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-12-26
Deactivation Date:2013-11-05
Deactivation Code:
Reactivation Date:2013-12-26
Provider Licenses
StateLicense IDTaxonomies
MDD0023319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7171Medicare ID - Type Unspecified
D73832Medicare UPIN