Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 200000602 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | 200000602 | NC |
NPI | 1265416788 |
---|---|
Provider Name | Daryl A Rosenbaum |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10187516 | (05) | VA |
1280M | BCBS (01) | |
182521 | MEDCOST (01) | |
22596 | PARTNERS (01) | |
3810002729 | (05) | WV |
7558309 | AETNA (01) | |
891280M | (05) | NC |
P00300135 | RR MEDICARE (01) | |
Q0060J | (05) | SC |