| Baltimore Suburban Health, Llc | |
|
4000 Old Court Rd Suite 301 Baltimore MD 21208-2800 | |
| (410) 653-0000 | |
| (410) 653-5531 |
| Full Name | Baltimore Suburban Health, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4000 Old Court Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Elliot S Rothschild (MANAGING MEMBER) |
| Authorized Official Contact | 4106530000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baltimore Suburban Health, Llc 4000 Old Court Rd Suite 301 Baltimore MD 21208-2800 Ph: (410) 653-0000 | Baltimore Suburban Health, Llc 4000 Old Court Rd Suite 301 Baltimore MD 21208-2800 Ph: (410) 653-0000 |
| NPI Number | 1013955723 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 11/24/2014 |
| Medicare PECOS PAC ID | 1850394677 |
|---|---|
| Medicare Enrollment ID | O20060817000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013955723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Maryland) | Primary |
| Provider Name | Miguel Sadovnik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366490351 PECOS PAC ID: 2567517550 Enrollment ID: I20090827000049 |
| Provider Name | Elliot S Rothschild |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346203866 PECOS PAC ID: 5193728913 Enrollment ID: I20100312000698 |
| Provider Name | Rachel S Benn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558412239 PECOS PAC ID: 8820127392 Enrollment ID: I20100520000829 |
| Provider Name | David R Roggen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992713622 PECOS PAC ID: 5597950030 Enrollment ID: I20101110000925 |
| Provider Name | Mark Girguis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477591154 PECOS PAC ID: 1850303165 Enrollment ID: I20150901000339 |
| Provider Name | Yury Malachevsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326443086 PECOS PAC ID: 0749583391 Enrollment ID: I20160114002452 |
| Provider Name | Nomy Thomas Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265046742 PECOS PAC ID: 5496161358 Enrollment ID: I20210302000252 |
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