Basic Information
| Provider Information | |||||||||
| NPI: | 1801859152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENBERG | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 CARLON DR | ||||||||
| Address2: | #B | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842178 | ||||||||
| FaxNumber: | 4135864233 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 CARLON DR | ||||||||
| Address2: | #B | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842178 | ||||||||
| FaxNumber: | 4135864233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50834 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 50834 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208000000X | 50834 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 508341 | 01 | MA | CONNECTICARE | OTHER | 04-3194547 | 01 | MA | GREAT-WEST | OTHER | 04-3194547 | 01 | MA | NORTHEAST HEALTH DIRECT | OTHER | 04-3194547 | 01 | MA | UNICARE/GIC | OTHER | 050834 | 01 | MA | TUFTS | OTHER | 000000008110 | 01 | MA | BMC | OTHER | 04-3194547 | 01 | MA | CONSOLIDATED | OTHER | 04-3194547 | 01 | MA | PLAN VISTA | OTHER | 2086123 | 05 | MA | MEDICAID | 20960 | 01 | MA | HARVARD PILGRIM | OTHER | J02106 | 01 | MA | BCBS MA | OTHER | 1293529 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | 16019 | 01 | MA | HNE | OTHER | 04-3194547 | 01 | MA | NORTHEAST HEALTHCARE ALLI | OTHER | 04-3194547 | 01 | MA | PHCS | OTHER | 04-3194547 | 01 | MA | UNITED HEALTHCARE | OTHER | 2381499 | 01 | MA | AETNA | OTHER | 10243101 | 01 | MA | CIGNA | OTHER |