Provider Demographics
NPI:1457367138
Name:ROSENBERG, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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 1:18370 BURBANK BLVD
Mailing Address - Street 2:STE 614
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2832
Mailing Address - Country:US
Mailing Address - Phone:818-996-6800
Mailing Address - Fax:818-996-2929
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:STE 614
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2832
Practice Address - Country:US
Practice Address - Phone:818-996-6800
Practice Address - Fax:818-996-2929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34887207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91367Medicare UPIN
CACB237313Medicare PIN
CAG34887BMedicare PIN
CAG34887Medicare PIN