Provider Demographics
NPI:1932285020
Name:ROTHENBERG, RUSSELL REED (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:REED
Last Name:ROTHENBERG
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 1:10215 FERNWOOD RD
Mailing Address - Street 2:401
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-571-2273
Mailing Address - Fax:301-571-0894
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:401
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-571-2273
Practice Address - Fax:301-571-0894
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027918207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC410086Medicare ID - Type Unspecified
DCC87813Medicare UPIN