Provider Demographics
NPI:1174597454
Name:ROSENBERG, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:58 MEADOWBROOK CNTRY CL EST
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1699
Mailing Address - Country:US
Mailing Address - Phone:314-420-6663
Mailing Address - Fax:636-227-2299
Practice Address - Street 1:58 MEADOWBROOK CNTRY CL EST
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-1699
Practice Address - Country:US
Practice Address - Phone:314-420-6663
Practice Address - Fax:636-227-2299
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5184207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00035718OtherRAILROAD MEDICARE
MO010013572Medicare ID - Type Unspecified
MOP00035718OtherRAILROAD MEDICARE