Provider Demographics
NPI:1871563395
Name:ROSENSTEIN, MAURY
Entity type:Individual
Prefix:
First Name:MAURY
Middle Name:
Last Name:ROSENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-766-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV272532085R0001X
KY387302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64127079Medicaid
KYC55023OtherCUMBERLAND HEALTH CARE
KY000000505636OtherANTHEM BC/BS
KY4648006OtherAETNA
KY61-1277847OtherHUMANA
KY61-1277847OtherUNITED HEALTH CARE
KYP00422878OtherRAILROAD MEDICARE
KY61-1277847OtherHUMANA
KY64127079Medicaid
KY0577911Medicare PIN
KY0510213Medicare PIN
PAF05016Medicare UPIN
KY61-1277847OtherUNITED HEALTH CARE
KY4648006OtherAETNA
KY0546613Medicare PIN
KYP00422878OtherRAILROAD MEDICARE