Healthcare Provider Details

I. General information

NPI: 1497840177
Provider Name (Legal Business Name): HERMINIA DIANA ROSAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN STREET WAC 835 NEUROLOGY ASSOCIATES
BOSTON MA
02114-3117
US

IV. Provider business mailing address

149 13TH ST RM 2275 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-2020
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1728
  • Fax: 617-724-1480
Mailing address:
  • Phone: 617-726-0658
  • Fax: 617-724-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number151574
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: