Basic Information
| Provider Information | |||||||||
| NPI: | 1720257934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROSEN HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ROSEN HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES PA SOCIA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8415 BELLONE LANE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212042066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Practice Location | |||||||||
| Address1: | 8415 BELLONE LANE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212042066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARKOWITZ | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4108217775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROSEN HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES PA | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 89NXRO | 01 | MD | CAREFIRST BCBS | OTHER | 90TGRO | 01 | MD | CAREFIRST BCBS | OTHER | K552RO | 01 | MD | CAREFIRST BCBS | OTHER |