Provider Demographics
NPI:1831518521
Name:ROSENBERGER, ELIZABETH UNDERWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:UNDERWOOD
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2560 BUSINESS PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6503
Mailing Address - Country:US
Mailing Address - Phone:423-472-5401
Mailing Address - Fax:423-479-3060
Practice Address - Street 1:2560 BUSINESS PARK DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-472-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD56961207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037882Medicaid