Provider Demographics
NPI:1639445646
Name:ROSENBLUM, JOSHUA ADAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ADAM
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353-8820
Mailing Address - Country:US
Mailing Address - Phone:802-365-7676
Mailing Address - Fax:
Practice Address - Street 1:185 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05353-8820
Practice Address - Country:US
Practice Address - Phone:802-365-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0909363A00000X
VT055.0031121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30339975Medicaid
NH002639902Medicare PIN