Healthcare Provider Details

I. General information

NPI: 1437183316
Provider Name (Legal Business Name): DENNIS ROSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE CHILDREN'S HOSPITAL BOSTON, MAILSTOP 208
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-1900
  • Fax: 617-730-0084
Mailing address:
  • Phone: 617-355-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number209474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: