Provider Demographics
NPI:1750337887
Name:GEORGE OD ROSENWASSER MD PC
Entity type:Organization
Organization Name:GEORGE OD ROSENWASSER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-577-4444
Mailing Address - Street 1:825 FISHBURN RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2015
Mailing Address - Country:US
Mailing Address - Phone:717-533-5200
Mailing Address - Fax:717-533-2606
Practice Address - Street 1:825 FISHBURN RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2015
Practice Address - Country:US
Practice Address - Phone:717-533-5200
Practice Address - Fax:717-533-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018400040001Medicaid
PA0018400040001Medicaid