Healthcare Provider Details

I. General information

NPI: 1881605103
Provider Name (Legal Business Name): CARL A ROSENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10160 BUSTLETON AVE SUITE A
PHILADELPHIA PA
19116
US

IV. Provider business mailing address

10160 BUSTLETON AVE SUITE A
PHILADELPHIA PA
19116
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-0770
  • Fax: 267-579-0720
Mailing address:
  • Phone: 215-464-0770
  • Fax: 267-579-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD026087E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: