Provider Demographics
NPI:1801454830
Name:ROSENBERG, MARK JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSHUA
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:202 WADE LN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7396
Mailing Address - Country:US
Mailing Address - Phone:480-241-8961
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST CSB 301, MSC 606
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-3222
Practice Address - Fax:843-876-1220
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL826922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology