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NPI Code Detail

MEDICARE: MICHAEL ROSENBAUM DMD

MEDICARE: MICHAEL ROSENBAUM 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
11223P0221XPediatric DentistryDS025205LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104810530
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ROSENBAUM DMD
Provider Business Mailing Address
First Line : 6404 ROOSEVELT BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2943
Country : US
Telephone Number : 215-743-3700
Fax Number : 215-743-3706
Provider Business Practice Location Address
First Line : 6404 ROOSEVELT BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2943
Country : US
Telephone Number : 215-743-3700
Fax Number : 215-743-3706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 04/02/2012

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Directions to “ MICHAEL ROSENBAUM DMD” Practice Location

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