MEDICARE: DR. EDWIN ROSENBERG B.D.S.H.DIP.DENT.DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	19706	PA

General Provider Information

NPI Number	:	1023175080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN ROSENBERG B.D.S.H.DIP.DENT.DMD

Provider Business Mailing Address
First Line	:	1500 LOCUST ST
Second Line	:	SUITE 1408
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4329
Country	:	US
Telephone Number	:	215-732-4450
Fax Number	:	215-722-3734

Provider Business Practice Location Address
First Line	:	1500 LOCUST ST
Second Line	:	SUITE 1408
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4329
Country	:	US
Telephone Number	:	215-732-4450
Fax Number	:	215-722-3734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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