Individual
MARK JACOB ROSENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 E PARHAM RD, RICHMOND, VA 23228-3118
(804) 264-7808
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101047611
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005811708
—
VA
01
—
080125856V
RAILROAD MEDICARE
VA
01
—
1440250
CIGNA
VA
01
—
204503
ANTHEM BCBS OF VA
VA
01
—
254731
MAMSI
VA
01
—
45891
SENTARA
VA
01
—
5526500
AETNA LIFE
VA
01
—
79136
SOUTHERN HEALTH SERVICES
VA
01
—
C05698
GROUP PTAN
VA
Enumeration date
06/28/2006
Last updated
04/09/2018
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