Provider Demographics
NPI:1346270402
Name:ROSENBERG, MATTHEW EAGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EAGAN
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 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1722
Mailing Address - Country:US
Mailing Address - Phone:530-795-4377
Mailing Address - Fax:
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1722
Practice Address - Country:US
Practice Address - Phone:530-795-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH72057Medicare UPIN