MEDICARE: MARK ROSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	N5368	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578561411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROSEN M.D.

Provider Business Mailing Address
First Line	:	408 W 45TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3014
Country	:	US
Telephone Number	:	512-451-5800
Fax Number	:	512-459-1399

Provider Business Practice Location Address
First Line	:	3000 NORTH IH 35
Second Line	:	SUITE 635
City	:	AUSTIN
State	:	TX
Zip	:	78705-1804
Country	:	US
Telephone Number	:	512-320-1500
Fax Number	:	512-320-1588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/21/2023

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Directions to “ MARK ROSEN M.D.” Practice Location

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