Healthcare Provider Details

I. General information

NPI: 1851382139
Provider Name (Legal Business Name): DOUGLAS MICHAEL ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MATTHEWS TOWNSHIP PKWY STE 230
MATTHEWS NC
28105-2388
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8615
  • Fax: 704-384-6792
Mailing address:
  • Phone: 704-333-1259
  • Fax: 704-333-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number200300403
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200300403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: