Provider Demographics
NPI:1841249232
Name:ROSENBLUM, IRA HOWARD (DO)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:HOWARD
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 SCHENCK ST
Practice Address - Street 2:STE 2
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5122
Practice Address - Country:US
Practice Address - Phone:980-487-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY79F421Medicare PIN
E87556Medicare UPIN