Healthcare Provider Details

I. General information

NPI: 1376871996
Provider Name (Legal Business Name): ALAN A. ROSEN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W. BELVEDERE AVENUE SUITE 306
BALTIMORE MD
21215
US

IV. Provider business mailing address

2411 W. BELVEDERE AVENUE SUITE 306
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8255
  • Fax:
Mailing address:
  • Phone: 410-601-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. ALAN A. ROSEN
Title or Position: C.E.O
Credential: D.O
Phone: 410-601-8255