Provider Demographics
NPI:1750552436
Name:ADAM G. TATTELBAUM, M.D., P.C.
Entity type:Organization
Organization Name:ADAM G. TATTELBAUM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-656-6398
Mailing Address - Street 1:3203 TOWER OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4260
Mailing Address - Country:US
Mailing Address - Phone:301-656-6398
Mailing Address - Fax:301-754-2503
Practice Address - Street 1:3203 TOWER OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4260
Practice Address - Country:US
Practice Address - Phone:301-656-6398
Practice Address - Fax:301-754-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
881266OtherMEDICARE PROVIDER NUMBER
VA6901212Medicaid
MDG04698Medicare UPIN