Healthcare Provider Details

I. General information

NPI: 1700862349
Provider Name (Legal Business Name): LAUREN SUE ROSENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JAMESTOWN ST SUITE 201
PHILA PA
19128-1751
US

IV. Provider business mailing address

PO BOX 820933
PHILA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-2412
  • Fax: 215-487-1251
Mailing address:
  • Phone: 215-482-2412
  • Fax: 215-487-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD058204L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: