Provider Demographics
NPI:1740398569
Name:ROSENBLUM, MARTIN JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JEROME
Last Name:ROSENBLUM
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 1:2200 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3106
Mailing Address - Country:US
Mailing Address - Phone:727-822-4729
Mailing Address - Fax:
Practice Address - Street 1:2200 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3106
Practice Address - Country:US
Practice Address - Phone:727-822-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL035930207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
62224YMedicare ID - Type Unspecified
D57353Medicare UPIN