Provider Demographics
NPI:1942294657
Name:ROSENBERG, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:207 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3204
Mailing Address - Country:US
Mailing Address - Phone:607-734-2984
Mailing Address - Fax:607-398-3411
Practice Address - Street 1:232 DENISON PKWY E
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2813
Practice Address - Country:US
Practice Address - Phone:607-937-5800
Practice Address - Fax:607-398-3341
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY165819207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180017694OtherRR MEDICARE
180017694OtherRR MEDICARE