Basic Information
| Provider Information | |||||||||
| NPI: | 1154490886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUTENBERG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 SOUTH DIVISION STREET | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105430400 | ||||||||
| FaxNumber: | 4108602603 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 SOUTH DIVISION STREET | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105430400 | ||||||||
| FaxNumber: | 4108602603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | D15857 | MD | X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208600000X | G26503 | CA | X | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | KAR850 | 01 | MD | BCBS MARYLAND | OTHER | 20882 | 01 | MD | COMMERCIAL | OTHER | S284 | 01 | BCBS DC NATL | OTHER |