Provider Demographics
NPI:1033308929
Name:LAWRENCE E. ROSENBERG, MDPC
Entity Type:Organization
Organization Name:LAWRENCE E. ROSENBERG, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-527-2130
Mailing Address - Street 1:18 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2214
Mailing Address - Country:US
Mailing Address - Phone:617-527-2130
Mailing Address - Fax:
Practice Address - Street 1:18 CHASE ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2214
Practice Address - Country:US
Practice Address - Phone:617-527-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA339572084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33957OtherLICENSE
MAMO8551OtherBLUE CROSS/BLUE SHIELD
MAMO8551OtherBLUE CROSS/BLUE SHIELD
MAMO8551OtherBLUE CROSS/BLUE SHIELD