Provider Demographics
NPI:1144337262
Name:ROSENBERG, STANLEY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ALLEN
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1830
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:2525 PASADENA AVENUE SOUTH
Practice Address - Street 2:SUITE U
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4559
Practice Address - Country:US
Practice Address - Phone:727-381-4430
Practice Address - Fax:727-381-9630
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22511207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057160100Medicaid
FLP01022905OtherMEDICARE RAILROAD PROVIDER NUMBER
FL057160100Medicaid
FL05328YMedicare PIN