Healthcare Provider Details

I. General information

NPI: 1194204701
Provider Name (Legal Business Name): CARLY BERNSTEIN ROSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH ST FL 5
BOSTON MA
02110-3036
US

IV. Provider business mailing address

200 HIGH ST FL 5
BOSTON MA
02110-3036
US

V. Phone/Fax

Practice location:
  • Phone: 617-221-6909
  • Fax: 617-507-5639
Mailing address:
  • Phone: 617-221-6909
  • Fax: 617-507-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPA6704
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: