Provider Demographics
NPI:1215031588
Name:ROSENFELD, JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LINDSAY CT
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-9564
Mailing Address - Country:US
Mailing Address - Phone:209-736-4305
Mailing Address - Fax:209-736-9088
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9359
Practice Address - Country:US
Practice Address - Phone:209-736-0041
Practice Address - Fax:209-736-9088
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD461900500Medicaid
C48744Medicare UPIN
B084Medicare ID - Type Unspecified