Provider Demographics
NPI:1942734694
Name:ROSENBERG, JESSICA JOY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOY
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 GUILFORD DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5266
Mailing Address - Country:US
Mailing Address - Phone:301-695-6800
Mailing Address - Fax:301-695-6891
Practice Address - Street 1:7109 GUILFORD DR STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5266
Practice Address - Country:US
Practice Address - Phone:013-695-6800
Practice Address - Fax:301-695-6891
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0099594207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology