Provider Demographics
NPI:1114114584
Name:ROSENBLUTH, EVAN (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:ROSENBLUTH
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 1:100 PARK PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-867-1800
Mailing Address - Fax:925-275-0933
Practice Address - Street 1:89 DAVIS RD
Practice Address - Street 2:SUITE 280
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3031
Practice Address - Country:US
Practice Address - Phone:925-973-5802
Practice Address - Fax:925-254-7810
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6360381-1205207V00000X
IA38404207VX0000X, 207VE0102X
CAA119897207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923227Medicare PIN