MEDICARE: DR. MARK RICHARD ROSENBERG DO

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	207N00000X	Dermatology Physician	2245	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00633842	OTHER	AZ	RAILROAD MEDICARE WEST DERM OF AZ
2	P00809240	OTHER		RR MEDICARE 4/2010 UNDER PTAN DP3049

General Provider Information

NPI Number	:	1598869687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RICHARD ROSENBERG DO

Provider Business Mailing Address
First Line	:	2285 CORPORATE CIR
Second Line	:	STE 200
City	:	HENDERSON
State	:	NV
Zip	:	89074-7759
Country	:	US
Telephone Number	:	702-360-2763
Fax Number	:	949-783-2880

Provider Business Practice Location Address
First Line	:	20950N TATUM BLVD 350
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4256
Country	:	US
Telephone Number	:	480-502-6651
Fax Number	:	480-513-8253

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	03/16/2016

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