Provider Demographics
NPI:1538285564
Name:CHARLES ROSENBAUM MD PC
Entity type:Organization
Organization Name:CHARLES ROSENBAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-481-4213
Mailing Address - Street 1:65 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1271
Mailing Address - Country:US
Mailing Address - Phone:508-481-4213
Mailing Address - Fax:508-481-7841
Practice Address - Street 1:65 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1271
Practice Address - Country:US
Practice Address - Phone:508-481-4213
Practice Address - Fax:508-481-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36848207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2074303Medicaid
MAM09127Medicare ID - Type UnspecifiedPHYSICIAN
MAB75972Medicare UPIN