Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 13350 | OH |
NPI | 1023198751 |
---|---|
Provider Name | Fredrick A Rosenberg |
First Address | Beachwood, OH 44122-4331 |
Second Address | Beachwood, OH 44122-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |