Provider Demographics
NPI:1508917899
Name:ROSENBERG, LAWRENCE ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ELLIOT
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 1:18 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2214
Mailing Address - Country:US
Mailing Address - Phone:617-527-2130
Mailing Address - Fax:
Practice Address - Street 1:18 CHASE ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2214
Practice Address - Country:US
Practice Address - Phone:617-527-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA339572084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMO8551OtherBLUE SHIELD NUMBER
MA33957OtherMA LICENSE NUMBER
MAAR5565443OtherDEA NUMBER
MAAR5565443OtherDEA NUMBER
MA33957OtherMA LICENSE NUMBER