Healthcare Provider Details

I. General information

NPI: 1437217122
Provider Name (Legal Business Name): JOHN A. ROSENFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 US HIGHWAY 23 N SUITE E
DELAWARE OH
43015-8960
US

IV. Provider business mailing address

1201 US HIGHWAY 23 N SUITE E
DELAWARE OH
43015-8960
US

V. Phone/Fax

Practice location:
  • Phone: 740-363-5755
  • Fax: 740-363-3117
Mailing address:
  • Phone: 740-363-5755
  • Fax: 740-363-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-04-4856-R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: