Provider Demographics
NPI:1073692125
Name:ROSENBERG, AVA WOLF (DO)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:WOLF
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1604 TOWN CENTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3640
Mailing Address - Country:US
Mailing Address - Phone:954-349-3030
Mailing Address - Fax:954-349-9337
Practice Address - Street 1:1604 TOWN CENTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3640
Practice Address - Country:US
Practice Address - Phone:954-349-3030
Practice Address - Fax:954-349-9337
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL6375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80770Medicare PIN
FLF53252Medicare UPIN