Provider Demographics
NPI:1801859152
Name:ROSENBERG, HENRY W (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:W
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CARLON DR
Mailing Address - Street 2:#B
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2373
Mailing Address - Country:US
Mailing Address - Phone:413-584-2178
Mailing Address - Fax:413-586-4233
Practice Address - Street 1:76 CARLON DR
Practice Address - Street 2:#B
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2373
Practice Address - Country:US
Practice Address - Phone:413-584-2178
Practice Address - Fax:413-586-4233
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50834207R00000X, 207RG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA508341OtherCONNECTICARE
MA04-3194547OtherGREAT-WEST
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherUNICARE/GIC
MA050834OtherTUFTS
MA000000008110OtherBMC
MA04-3194547OtherCONSOLIDATED
MA04-3194547OtherPLAN VISTA
MA2086123Medicaid
MA20960OtherHARVARD PILGRIM
MAJ02106OtherBCBS MA
MA1293529OtherFALLON COMMUNITY HEALTH PLAN
MA16019OtherHNE
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA04-3194547OtherPHCS
MA04-3194547OtherUNITED HEALTHCARE
MA2381499OtherAETNA
MA10243101OtherCIGNA
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherPHCS
MA508341OtherCONNECTICARE