Healthcare Provider Details

I. General information

NPI: 1902901739
Provider Name (Legal Business Name): DAVID A ROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW TOWER 3400
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-3785
  • Fax: 202-865-3131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD19668
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: