Basic Information
| Provider Information | |||||||||
| NPI: | 1174629042 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARL ROSENBAUM MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10160 BUSTLETON AVE | ||||||||
| Address2: | #A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154640770 | ||||||||
| FaxNumber: | 2154648208 | ||||||||
| Practice Location | |||||||||
| Address1: | 10160 BUSTLETON AVE | ||||||||
| Address2: | #A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154640770 | ||||||||
| FaxNumber: | 2154648208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROSENBAUM | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2154640770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD026087E | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.