Provider Demographics
NPI:1558344010
Name:ROSENBAUM, TERRI F (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:F
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S BROADWAY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5971
Mailing Address - Country:US
Mailing Address - Phone:303-649-3240
Mailing Address - Fax:720-582-9903
Practice Address - Street 1:805 S BROADWAY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5971
Practice Address - Country:US
Practice Address - Phone:303-649-3240
Practice Address - Fax:720-582-9903
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39502333Medicaid
COP00290433Medicare PIN
COC97591Medicare UPIN
CO327416YLTTMedicare UPIN
CO39502333Medicaid