Provider Demographics
NPI:1033132857
Name:PEDIATRIC PULMONARY SPECIALISTS PA
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-1995
Mailing Address - Street 1:PO BOX 151637
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1637
Mailing Address - Country:US
Mailing Address - Phone:813-870-1995
Mailing Address - Fax:813-875-1889
Practice Address - Street 1:4714 N ARMENIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-870-1995
Practice Address - Fax:813-875-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00569422080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2414608OtherAETNA
FL01424OtherSTAYWELL
FL100789OtherAVMED
FL204478OtherAMERIGROUP
FL274523200Medicaid
FLF33317Medicare UPIN
FL274523200Medicaid