Provider Demographics
NPI:1144685207
Name:ROTENBERG, ROBERT (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROTENBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S CHARLES ST UNIT 323
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3881
Mailing Address - Country:US
Mailing Address - Phone:303-921-7325
Mailing Address - Fax:
Practice Address - Street 1:10084 REISTERSTOWN RD STE 200A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4096
Practice Address - Country:US
Practice Address - Phone:410-552-5050
Practice Address - Fax:410-552-0200
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL33902255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer