Provider Demographics
NPI:1962430751
Name:ROSENBERG, JASON DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DAVID
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 ST PAUL PLACE
Mailing Address - Street 2:POB 804
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-649-3485
Mailing Address - Fax:410-659-2817
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:804
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-649-3485
Practice Address - Fax:410-659-2817
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD601842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402083900Medicaid
MDKR37G171Medicare PIN
MD402083900Medicaid