Basic Information
| Provider Information | |||||||||
| NPI: | 1477896108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENBERG | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 82 CATAMOUNT PARK | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057531292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023887185 | ||||||||
| FaxNumber: | 8023883445 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 CATAMOUNT PARK | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057531292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023887185 | ||||||||
| FaxNumber: | 8023883445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 265497 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 19474 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 042.0014590 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3117969 | 05 | NH | MEDICAID |