Provider Demographics
NPI:1124069737
Name:ROSENBERG, CARL E (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 PORTAGE TRAIL EXT W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3613
Mailing Address - Country:US
Mailing Address - Phone:330-923-0228
Mailing Address - Fax:330-923-1020
Practice Address - Street 1:267 PORTAGE TRAIL EXT W
Practice Address - Street 2:SUITE 100
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3613
Practice Address - Country:US
Practice Address - Phone:330-923-0228
Practice Address - Fax:330-923-1020
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072064L2084N0400X, 2084S0012X
OH35.0613932084N0400X
OH35-0613932084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01972086Medicaid
PA01972086Medicaid
OH7396011Medicare PIN
PA058411E8YMedicare ID - Type Unspecified
NJ058579PSPMedicare ID - Type Unspecified