MEDICARE: PEDIATRIC PULMONARY SPECIALISTS PA

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	2080P0214X	Pediatric Pulmonology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1790931491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PULMONARY SPECIALISTS PA

Provider Business Mailing Address
First Line	:	PO BOX 151637
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-1637
Country	:	US
Telephone Number	:	813-870-1995
Fax Number	:	813-875-1889

Provider Business Practice Location Address
First Line	:	10817 BLOOMINGDALE AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-3616
Country	:	US
Telephone Number	:	813-870-1995
Fax Number	:	813-875-1889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID ROSENBERG
Credential	:	M.D.
Telephone Number	:	813-870-1995

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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