Provider Demographics
NPI:1780618470
Name:ROSENBERG, LEON H (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:H
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 1:1735 27TH ST
Mailing Address - Street 2:WALLER BUILDING, SUITE B06
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-356-8800
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1735 27TH ST
Practice Address - Street 2:WALLER BUILDING, SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2677
Practice Address - Country:US
Practice Address - Phone:740-356-9240
Practice Address - Fax:740-355-9281
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350474022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485541Medicaid
OH0485541Medicaid
A15082Medicare UPIN