Provider Demographics
NPI:1174629042
Name:CARL ROSENBAUM MD PC
Entity type:Organization
Organization Name:CARL ROSENBAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-464-0770
Mailing Address - Street 1:10160 BUSTLETON AVE
Mailing Address - Street 2:#A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:215-464-0770
Mailing Address - Fax:215-464-8208
Practice Address - Street 1:10160 BUSTLETON AVE
Practice Address - Street 2:#A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-464-0770
Practice Address - Fax:215-464-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026087E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty