Provider Demographics
NPI:1114909108
Name:ROSENBERG, STEVEN PETER (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PETER
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 1:470 COLUMBIA DR
Mailing Address - Street 2:#102A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1997
Mailing Address - Country:US
Mailing Address - Phone:561-640-4400
Mailing Address - Fax:561-640-8098
Practice Address - Street 1:470 COLUMBIA DR
Practice Address - Street 2:#102A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1997
Practice Address - Country:US
Practice Address - Phone:561-640-4400
Practice Address - Fax:561-640-8098
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036848207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50966ZMedicare PIN
D55925Medicare UPIN