Provider Demographics
NPI:1851533434
Name:ROSENBERGER, KATHIE LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:LEIGH
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-425-3981
Mailing Address - Fax:215-425-8083
Practice Address - Street 1:8 HUNTINGDON PIKE STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4351
Practice Address - Country:US
Practice Address - Phone:215-663-8880
Practice Address - Fax:215-663-8898
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001402L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PACD4829OtherRAILROAD MEDICARE GROUP
PA182908Medicare PIN