Provider Demographics
NPI:1700862349
Name:ROSENBERG, LAUREN SUE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-482-2412
Mailing Address - Fax:215-487-1251
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-482-2412
Practice Address - Fax:215-487-1251
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD058204L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2Y0395OtherHEALTH NET
PA001599604Medicaid
PA544693OtherCOVENTRY HEALTH AMERICA
PA0579789OtherAETNA HMMO
PA5093388OtherAETNA PPO
PA712OtherBRAVO HEALTH
PA0113247000OtherINDEPENDENCE BLUE CROSS
PAP625645OtherOXFORD
PA885575OtherHIGHMARK BLUE SHIELD
PA080097571OtherRAILROAD MEDICARE
PA1075742OtherKEYSTONE MERCY HEALTH
PA712OtherBRAVO HEALTH
PA080097571OtherRAILROAD MEDICARE