Healthcare Provider Details

I. General information

NPI: 1326426495
Provider Name (Legal Business Name): JULIA MARGUERITE ROSENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST YNHH DEPARTMENT OF PEDIATRICS
NEW HAVEN CT
06510
US

IV. Provider business mailing address

333 CEDAR ST YNHH DEPARTMENT OF PEDIATRICS
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-1947
  • Fax:
Mailing address:
  • Phone: 203-688-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60355
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: