Jordin Mazer Rosenberger, DNP, CPNP-PC
Individual provider Active NPI Pediatrics Physician · Perryville, MD
NPI 1780350140 · NPPES record last updated Aug 17, 2021
Key facts
- NPI
- 1780350140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- R211132 (MD)
- Practice address
- 4863 Pulaski Hwy Ste 120
Perryville, MD 21903-1623 - Phone
- (410) 642-9172
- NPI assigned
- Aug 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R211132 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| L & W Pediatrics PA | Pediatrics | Past | Accepting new patients |
| Sanchez Counseling, LLC | Single Specialty | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | R211132 | MD | Yes |
Addresses
Primary practice location
4863 Pulaski Hwy Ste 120
Perryville, MD 21903-1623
Mailing address
4863 Pulaski Hwy Ste 120
Perryville, MD 21903-1623
Phone (410) 642-9172
Other providers in Perryville, MD
- Janice Marie Nosek
- Erica J Oliphant
- Ian R Ponen
- Stanley Prochaska Jr.
- Carol Samuel Robinson
- Sanchez Counseling, LLC
- Edith Ann Serrano
- Alexis Shallcross
- Gillian Simon
- Sokoloff Management, LLC
All providers in Perryville, MD · Pediatrics Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.