Basic Information
| Provider Information | |||||||||
| NPI: | 1407846769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RODNEY E. GROLMAN, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 CHARLES PLZ | ||||||||
| Address2: | APT 2704 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212014238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103682700 | ||||||||
| FaxNumber: | 4103683569 | ||||||||
| Practice Location | |||||||||
| Address1: | 3421 BENSON AVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103682700 | ||||||||
| FaxNumber: | 4103683569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GROLMAN | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | EDMIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4103682700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D0060134 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 62011001 | 01 | MD | BLUE SHIELD | OTHER | K1550001 | 01 | DC | BLUE SHIELD | OTHER |