Basic Information
| Provider Information | |||||||||
| NPI: | 1780350140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENBERGER | ||||||||
| FirstName: | JORDIN | ||||||||
| MiddleName: | MAZER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4863 PULASKI HWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | PERRYVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219031623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4863 PULASKI HWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | PERRYVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219031623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R211132 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.