Provider Demographics
NPI:1699731810
Name:PROFESSIONAL MANAGEMENT SERVICES, LLC
Entity type:Organization
Organization Name:PROFESSIONAL MANAGEMENT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-580-0255
Mailing Address - Street 1:1 SLADE AVE
Mailing Address - Street 2:#405
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5240
Mailing Address - Country:US
Mailing Address - Phone:410-580-0255
Mailing Address - Fax:888-241-3302
Practice Address - Street 1:707 OLD CROSSING DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3308
Practice Address - Country:US
Practice Address - Phone:410-580-0255
Practice Address - Fax:410-486-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00794OtherMEDICARE PIN
MD750400400Medicaid
DCG00794OtherMEDICARE PIN
MD750400400Medicaid