Provider Demographics
NPI:1821164542
Name:ROSENBLOOM, MARK K (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:K
Last Name:ROSENBLOOM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 FOUCHER STREET
Mailing Address - Street 2:M1005
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115
Mailing Address - Country:US
Mailing Address - Phone:504-897-8543
Mailing Address - Fax:504-897-8726
Practice Address - Street 1:1401 FOUCHER STREET M1005
Practice Address - Street 2:GARY R GLYNN MD APMC
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-897-8543
Practice Address - Fax:504-897-8726
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-06-04
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Provider Licenses
StateLicense IDTaxonomies
LA07565R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925594Medicaid
LA5L452Medicare PIN
E31855Medicare UPIN