Healthcare Provider Details

I. General information

NPI: 1578669305
Provider Name (Legal Business Name): DAVID M ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AUBURN DR # 200
BEACHWOOD OH
44122-4317
US

IV. Provider business mailing address

1000 AUBURN DR # 200
BEACHWOOD OH
44122-4317
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-5864
  • Fax: 216-201-7853
Mailing address:
  • Phone: 216-593-5864
  • Fax: 216-201-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35043346R
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number43346
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: