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General NPI Number Information
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NPI Number | 1083077846
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Entity Type | Individual
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Provider Name | LUCY ROSENBAUM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 75 JOHN ROBERTS RD BLDG B
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6967
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Country | US
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Telephone | 207-775-4151
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Fax |
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Provider Business Mailing Address
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Address Line | 75 JOHN ROBERTS RD BLDG B
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6967
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Country | US
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Telephone | 207-775-4151
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Fax | 317-777-6644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD28267
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD28267
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MD28267
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License Number State | ME
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