Provider Demographics
NPI:1427033083
Name:ROSENBERG, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
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 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2209
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-881-1094
Practice Address - Fax:404-885-7777
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47360207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00944996DMedicaid
GA00944996DMedicaid
GAH57480Medicare UPIN