Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 23441 | WV |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35.083418 | OH |
NPI | 1235293275 |
---|---|
Provider Name | Matthew William Rosenberg |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Gallipolis, OH 45631-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000241633 | OH MEDICAID MOLINA (01) | OH |
000000241633 | OH MEDICAID UNISON (01) | OH |
2444000 | (05) | OH |
310917085189 | OH MEDICAID CARESOURCE (01) | OH |
3810002080 | (05) | WV |