Provider Demographics
NPI:1750666111
Name:DAVID ROSENSTOCK, M.D., P.A,
Entity Type:Organization
Organization Name:DAVID ROSENSTOCK, M.D., P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-709-8500
Mailing Address - Street 1:3443 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3459
Mailing Address - Country:US
Mailing Address - Phone:972-709-8500
Mailing Address - Fax:972-709-8555
Practice Address - Street 1:3443 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3459
Practice Address - Country:US
Practice Address - Phone:972-709-8500
Practice Address - Fax:972-709-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143912Medicare PIN
TXB26020Medicare UPIN