Provider Demographics
NPI:1417964198
Name:ROSENBERG, RONALD E (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ESTATE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0601
Mailing Address - Country:US
Mailing Address - Phone:901-382-1113
Mailing Address - Fax:901-767-3480
Practice Address - Street 1:920 ESTATE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0601
Practice Address - Country:US
Practice Address - Phone:901-382-1113
Practice Address - Fax:901-767-3480
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2592016OtherCIGNA
TN2008082OtherBLUE CROSS SHIELD OF TN
TN3350317Medicaid
TN3350317Medicaid
TN2592016OtherCIGNA