Provider Demographics
NPI:1306929757
Name:ROSENBERG, STANLEY ALLAN (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:ALLAN
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 1:10371 PARKGLENN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3871
Mailing Address - Country:US
Mailing Address - Phone:303-841-2905
Mailing Address - Fax:303-841-3052
Practice Address - Street 1:10371 PARKGLENN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3871
Practice Address - Country:US
Practice Address - Phone:303-841-2905
Practice Address - Fax:303-841-3052
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO23060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01230606Medicaid