Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2019018216 | MO |
NPI | 1033672662 |
---|---|
Provider Name | Dr. Abby Rachel Rosenberg |
First Address | Saint Louis, MO 63110-2323 |
Second Address | Richmond Heights, MO 63117-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 17/06/2020 |