Provider Demographics
NPI:1881694404
Name:ROSENBERG, WADE RONALD (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:RONALD
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 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-790-4830
Mailing Address - Fax:713-793-7824
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-790-4830
Practice Address - Fax:713-793-7824
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124931002Medicaid
TXP01263888OtherRR MEDICARE
TX124931005Medicaid
TX8GD960OtherBCBS
TX89819BOtherBCBS
TX8DW161OtherBLUE CROSS BLUE SHIELD
TX8DW161OtherBLUE CROSS BLUE SHIELD
TX124931005Medicaid
TXP01263888OtherRR MEDICARE
TX124931002Medicaid