MEDICARE: DR. DOROTHY H ROSENKE PSYD

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	103T00000X	Psychologist	2704	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417933052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY H ROSENKE PSYD

Provider Business Mailing Address
First Line	:	905 HALSTEAD BLVD STE 7&8
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6986
Country	:	US
Telephone Number	:	252-335-2018
Fax Number	:	252-335-9521

Provider Business Practice Location Address
First Line	:	905 HALSTEAD BLVD # 78
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6986
Country	:	US
Telephone Number	:	252-335-2018
Fax Number	:	252-335-9521

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	01/30/2025

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