Provider Demographics
NPI:1720057573
Name:ROSENBERG, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:6100 GLADES RD STE 304
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4372
Mailing Address - Country:US
Mailing Address - Phone:561-886-0976
Mailing Address - Fax:561-367-7388
Practice Address - Street 1:6100 GLADES RD STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4372
Practice Address - Country:US
Practice Address - Phone:561-886-0976
Practice Address - Fax:561-367-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070312207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271026900Medicaid
FL2899973OtherGHI
FLP00203635OtherRR MCR
FL11352415OtherUNITED HEALTH CARE
FL0176932OtherCIGNA
FL31523OtherBCBS
FLK5738OtherMEDICARE GROUP PIN
FL271026900Medicaid
FL0176932OtherCIGNA
FLK5738OtherMEDICARE GROUP PIN