Provider Demographics
NPI:1760577126
Name:RUSINOWITZ, MARTIN STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:STEVEN
Last Name:RUSINOWITZ
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 1:10903 NEW HAMPSHIRE AVE
Mailing Address - Street 2:BLDG. 22 RM.4345
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1058
Mailing Address - Country:US
Mailing Address - Phone:301-796-0158
Mailing Address - Fax:301-796-9842
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE
Practice Address - Street 2:BLDG. 22 RM.4345
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1058
Practice Address - Country:US
Practice Address - Phone:301-796-0158
Practice Address - Fax:301-796-9842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00B799T91Medicare ID - Type Unspecified
MDB94430Medicare UPIN