Provider Demographics
NPI:1356456560
Name:ROSENBERG, MARC (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301A W PALMETTO PARK RD STE 305A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3466
Mailing Address - Country:US
Mailing Address - Phone:561-883-0007
Mailing Address - Fax:561-883-9884
Practice Address - Street 1:9250 GLADES RD
Practice Address - Street 2:STE 108
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-883-0007
Practice Address - Fax:561-883-9884
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F30070Medicare UPIN
FL80637Medicare ID - Type Unspecified