MEDICARE: LAUREN SUE ROSENBERG MD

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	207Q00000X	Family Medicine Physician	MD058204L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	080097571	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Y0395	OTHER	PA	HEALTH NET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	544693	OTHER	PA	COVENTRY HEALTH AMERICA
4	0579789	OTHER	PA	AETNA HMMO
5	5093388	OTHER	PA	AETNA PPO
6	712	OTHER	PA	BRAVO HEALTH
7	0113247000	OTHER	PA	INDEPENDENCE BLUE CROSS
8	P625645	OTHER	PA	OXFORD
9	885575	OTHER	PA	HIGHMARK BLUE SHIELD
11	1075742	OTHER	PA	KEYSTONE MERCY HEALTH

General Provider Information

NPI Number	:	1700862349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN SUE ROSENBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-482-2412
Fax Number	:	215-487-1251

Provider Business Practice Location Address
First Line	:	525 JAMESTOWN ST
Second Line	:	SUITE 201
City	:	PHILA
State	:	PA
Zip	:	19128-1751
Country	:	US
Telephone Number	:	215-482-2412
Fax Number	:	215-487-1251

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/21/2013

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Directions to “ LAUREN SUE ROSENBERG MD” Practice Location

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