Provider Demographics
NPI:1932193877
Name:ROSENBAUM, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 COURTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1724
Mailing Address - Country:US
Mailing Address - Phone:978-934-9294
Mailing Address - Fax:978-934-0056
Practice Address - Street 1:6 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1724
Practice Address - Country:US
Practice Address - Phone:978-934-9294
Practice Address - Fax:978-934-0056
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44591207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0004655OtherNEIGHBORHOOD HEALTH PLAN
MA20335OtherFALLON HEALTH PAN
MA712126OtherTUFTS HEALTH PLAN
MA03-00030OtherUNITED HEALTH
MA4143OtherHARVARD PILGRIM
MA4143OtherHARVARD PILGRIM
B97214Medicare UPIN