Provider Demographics
NPI:1881605103
Name:ROSENBAUM, CARL A (MD)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10160 BUSTLETON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:215-464-0770
Mailing Address - Fax:267-579-0720
Practice Address - Street 1:10160 BUSTLETON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-464-0770
Practice Address - Fax:267-579-0720
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026087E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
608783Medicare ID - Type Unspecified
C33807Medicare UPIN