Basic Information
Provider Information | |||||||||
NPI: | 1952822561 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ROSEN HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1001 CROMWELL BRIDGE RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | TOWSON | ||||||||
State: | MD | ||||||||
PostalCode: | 212863330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108217775 | ||||||||
FaxNumber: | 4108211320 | ||||||||
Practice Location | |||||||||
Address1: | 1001 CROMWELL BRIDGE RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | TOWSON | ||||||||
State: | MD | ||||||||
PostalCode: | 212863330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108217775 | ||||||||
FaxNumber: | 4108211320 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2017 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DELOACH | ||||||||
AuthorizedOfficialFirstName: | DEANNA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
AuthorizedOfficialTelephone: | 4108217775 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MISS | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083T0002X | 21D1100810 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Medical Toxicology |
No ID Information.