Provider Demographics
NPI:1699756684
Name:ROSENBERG, NAOMI (MD)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-8105
Practice Address - Street 1:94 N ELM ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1647
Practice Address - Country:US
Practice Address - Phone:413-562-1650
Practice Address - Fax:413-562-1603
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154880207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110061271/AMedicaid
NH990015377OtherRR MEDICARE PIN
NH990015377OtherRR MEDICARE PIN
F69605Medicare UPIN