Healthcare Provider Details

I. General information

NPI: 1700927613
Provider Name (Legal Business Name): WALTER C ROSE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BILTMORE AVE 407
ASHEVILLE NC
28801-4565
US

IV. Provider business mailing address

29 REEMS TRACE RD
WEAVERVILLE NC
28787-8414
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-0397
  • Fax:
Mailing address:
  • Phone: 828-645-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103502
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103502
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: