Provider Demographics
NPI:1073728556
Name:ROSENBERG, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11839
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-4839
Mailing Address - Country:US
Mailing Address - Phone:340-774-0265
Mailing Address - Fax:340-776-0228
Practice Address - Street 1:9149 ESTATE THOMAS, PARAGON MEDICAL BUILDING
Practice Address - Street 2:STE 103
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-0265
Practice Address - Fax:340-776-0228
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI7452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0029895AMedicare ID - Type Unspecified
VID83360Medicare UPIN