Provider Demographics
NPI:1235293275
Name:ROSENBERG, MATTHEW WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIAM
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5225
Mailing Address - Fax:740-441-8097
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5225
Practice Address - Fax:740-441-8097
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV234412086S0122X
OH35.0834182086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444000Medicaid
OH000000241633OtherOH MEDICAID MOLINA
WV3810002080Medicaid
OH000000241633OtherOH MEDICAID UNISON
OH310917085189OtherOH MEDICAID CARESOURCE
OH000000241633OtherOH MEDICAID MOLINA
OHRO4120604Medicare PIN