Provider Demographics
NPI:1780350140
Name:ROSENBERGER, JORDIN MAZER (DNP, CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:JORDIN
Middle Name:MAZER
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 PULASKI HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-1623
Mailing Address - Country:US
Mailing Address - Phone:410-642-9172
Mailing Address - Fax:
Practice Address - Street 1:4863 PULASKI HWY STE 120
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-1623
Practice Address - Country:US
Practice Address - Phone:410-642-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty