Provider Demographics
NPI:1306806922
Name:ROSENBERG, GORDON S (MD)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:S
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 1:15151 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2627
Mailing Address - Country:US
Mailing Address - Phone:408-356-0431
Mailing Address - Fax:408-358-1602
Practice Address - Street 1:15151 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2627
Practice Address - Country:US
Practice Address - Phone:408-356-0431
Practice Address - Fax:408-358-1602
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65167207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G651670Medicare ID - Type Unspecified
CAE30307Medicare UPIN