Provider Demographics
NPI:1801219373
Name:ROSENBERG, FREDRIC KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:KEVIN
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 COCHISE DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4319
Mailing Address - Country:US
Mailing Address - Phone:770-434-1753
Mailing Address - Fax:770-434-7512
Practice Address - Street 1:3270 COCHISE DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4319
Practice Address - Country:US
Practice Address - Phone:770-434-1753
Practice Address - Fax:770-434-7512
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220442083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine