MEDICARE: DR LEONARD E ROSENFELD PC

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	207R00000X	Internal Medicine Physician	OS001780L	PA

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	:	1912037847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LEONARD E ROSENFELD PC

Provider Business Mailing Address
First Line	:	1740 SOUTH ST STE 402
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-382-6112
Fax Number	:	215-382-6115

Provider Business Practice Location Address
First Line	:	1740 SOUTH ST STE 402
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-382-6112
Fax Number	:	215-382-6115

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	RUTH JAMISON
Credential	:
Telephone Number	:	267-792-1101

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/08/2020

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