Provider Demographics
NPI:1669563912
Name:ROSOFF, PAUL MARTIN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MARTIN
Last Name:ROSOFF
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 1:7575 RITCHIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-8951
Mailing Address - Country:US
Mailing Address - Phone:410-766-1444
Mailing Address - Fax:410-766-9453
Practice Address - Street 1:7575 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-8951
Practice Address - Country:US
Practice Address - Phone:410-766-1444
Practice Address - Fax:410-766-9453
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017640208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34953001OtherBSMD
639AMedicare ID - Type Unspecified
C48910Medicare UPIN