MEDICARE: DR. CLAIRE BRABEC ROSENBLATT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	23121	MS
2	207R00000X	Internal Medicine Physician	23121	MS

General Provider Information

NPI Number	:	1124315742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAIRE BRABEC ROSENBLATT M.D.

Provider Business Mailing Address
First Line	:	1513 LAKELAND DR
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-354-4836
Fax Number	:	601-354-2619

Provider Business Practice Location Address
First Line	:	1513 LAKELAND DR
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-354-4836
Fax Number	:	601-354-2619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2011
Last Update Date	:	03/07/2023

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