Provider Demographics
NPI:1114546868
Name:ROSENBERG, EVAN C (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:C
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6103
Mailing Address - Country:US
Mailing Address - Phone:215-829-6500
Mailing Address - Fax:215-829-6606
Practice Address - Street 1:330 S 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6103
Practice Address - Country:US
Practice Address - Phone:215-829-6500
Practice Address - Fax:215-829-6606
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4845842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology