Provider Demographics
NPI:1922137868
Name:OSTROVSKY, ROMAN (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:OSTROVSKY
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 1:8186 LARK BROWN RD STE 303
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6435
Mailing Address - Country:US
Mailing Address - Phone:443-803-4578
Mailing Address - Fax:410-486-2638
Practice Address - Street 1:8186 LARK BROWN RD STE 303
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6435
Practice Address - Country:US
Practice Address - Phone:443-803-4578
Practice Address - Fax:410-486-2638
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD515632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG43495Medicare UPIN