Provider Demographics
NPI:1427099613
Name:ROSENBERGER, MATTHEW (PAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 GREENWAY
Mailing Address - Street 2:#B
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5223
Mailing Address - Country:US
Mailing Address - Phone:509-985-7778
Mailing Address - Fax:
Practice Address - Street 1:206 S 11TH AVE STE 48
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3205
Practice Address - Country:US
Practice Address - Phone:509-575-5058
Practice Address - Fax:509-575-5196
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49222Medicare UPIN
WAG8901681Medicare PIN