Provider Demographics
NPI:1699777474
Name:ROSEMAN, BARRY J (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1218 W PACES FERRY RD NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2308
Mailing Address - Country:US
Mailing Address - Phone:404-841-6262
Mailing Address - Fax:888-343-1740
Practice Address - Street 1:1218 W PACES FERRY RD NW
Practice Address - Street 2:SUITE 204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2308
Practice Address - Country:US
Practice Address - Phone:404-841-6262
Practice Address - Fax:888-343-1740
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67600208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3812866Medicaid
GA3812866Medicaid
TNF16256Medicare UPIN