Provider Demographics
NPI:1184733065
Name:ROSENBERG, KENNETH C (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4180
Mailing Address - Fax:215-873-0201
Practice Address - Street 1:1015 CHESTNUT ST STE 512
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4305
Practice Address - Country:US
Practice Address - Phone:267-479-4180
Practice Address - Fax:215-873-0201
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023084E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0055166000OtherIBC
PA0009081150005Medicaid
PA0431147OtherHIGHMARK BLUE SHIELD
PA0431147OtherHIGHMARK BLUE SHIELD
PA0009081150003Medicaid
PA110137077Medicare PIN