MEDICARE: DR. ANDREW JORDAN ROSENFELD 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	207Q00000X	Family Medicine Physician	0102206922	VA
2	208M00000X	Hospitalist Physician	0102206922	VA

General Provider Information

NPI Number	:	1740772359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW JORDAN ROSENFELD DO

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	16431 WISE ST
Second Line	:
City	:	SAINT PAUL
State	:	VA
Zip	:	24283-3537
Country	:	US
Telephone Number	:	276-762-2300
Fax Number	:

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

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	02/22/2024

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