Healthcare Provider Details

I. General information

NPI: 1538201215
Provider Name (Legal Business Name): BARRY B ROSEMAN D.M.D M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/30/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BROOKWOOD LN
HOCKESSIN DE
19707-9536
US

IV. Provider business mailing address

730 BROOKWOOD LN
HOCKESSIN DE
19707-9536
US

V. Phone/Fax

Practice location:
  • Phone: 302-764-7714
  • Fax:
Mailing address:
  • Phone: 302-229-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG1-0000893
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0002254
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: