Provider Demographics
NPI:1720017239
Name:ROSENBERG, STEVEN (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NORTHEAST GATEWAY CT NE
Mailing Address - Street 2:204
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2440
Mailing Address - Country:US
Mailing Address - Phone:704-403-7020
Mailing Address - Fax:704-403-7039
Practice Address - Street 1:1090 NORTHEAST GATEWAY CT NE
Practice Address - Street 2:204
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2440
Practice Address - Country:US
Practice Address - Phone:704-403-7020
Practice Address - Fax:704-403-7039
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010768363A00000X
NC0010-02246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342616OtherMEDICARE PTAN, GROUP
NCNC2843AOtherMEDICARE PTAN, INDIVIDUAL
NC2342616OtherMEDICARE PTAN, GROUP