Provider Demographics
NPI:1992847321
Name:VONROSENVINGE, ERIK C (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:C
Last Name:VONROSENVINGE
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 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8750
Mailing Address - Fax:410-328-8315
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:N3W62
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8750
Practice Address - Fax:410-328-8315
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64431207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417449600Medicaid
MDS062-0356OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD951668-01 & 02OtherBLUE CROSS/BLUE SHIELD
MDP00855768Medicare PIN
MD154376Y1PMedicare PIN