Individual
MR. DENNIS W RIVENBURGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSTISTANT
Contact information
Practice address
5051 GREENSPRING AVE, BALTIMORE, MD 21209-4354
(410) 601-9515
(410) 601-8905
Mailing address
601 N CAROLINE ST FL 5, BALTIMORE, MD 21287-0006
(410) 955-6825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA3490
FL
363AM0700X
Medical Physician Assistant
Primary
C0004803
MD
363AS0400X
Surgical Physician Assistant
PA3490
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290365200
—
FL
01
—
970005415
RAILROAD MEDICARE
—
Enumeration date
11/18/2005
Last updated
10/01/2018
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