Healthcare Provider Details

I. General information

NPI: 1477746923
Provider Name (Legal Business Name): JUSTIN DAVID ROSENBERGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S ARLINGTON AVE DEPT OF
HARRISBURG PA
17109-5004
US

IV. Provider business mailing address

875 S ARLINGTON AVE DEPT OF
HARRISBURG PA
17109-5004
US

V. Phone/Fax

Practice location:
  • Phone: 717-652-1107
  • Fax:
Mailing address:
  • Phone: 717-652-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS013693
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: