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Individual

MR. ILYA ROZENBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS/CRNP

Contact information

Practice address
7452 BALTIMORE ANNAPOLIS BLVD, SUITE 107, GLEN BURNIE, MD 21061-3547
(410) 766-1544
(410) 766-1551
Mailing address
3 MARCIE WOODS CT, BALTIMORE, MD 21208-1965
(410) 766-1544
(410) 766-1551

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R143360
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
402464800
MD
05
463350400
MD
Enumeration date
08/03/2006
Last updated
10/03/2014
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