Provider Demographics
NPI:1245501337
Name:ROSENBERGER, THOMAS GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GRANT
Last Name:ROSENBERGER
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 1:503 STUART CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3531
Mailing Address - Country:US
Mailing Address - Phone:319-337-7414
Mailing Address - Fax:
Practice Address - Street 1:503 STUART CT
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3531
Practice Address - Country:US
Practice Address - Phone:319-337-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics