Provider Demographics
NPI:1407969777
Name:ROSENBERG, JASON C (M D)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0523
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:4731 HWY 17 BYPASS SOUTH
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-2673
Practice Address - Country:US
Practice Address - Phone:843-839-7246
Practice Address - Fax:843-839-7323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24751208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC202435512OtherSTANDARD TAX ID
SC247512Medicaid
SCAA05918222Medicare PIN
SC202435512OtherSTANDARD TAX ID
SCAA0591A278Medicare UPIN
SCI14792Medicare UPIN