Healthcare Provider Details

I. General information

NPI: 1205828886
Provider Name (Legal Business Name): DANIEL TODD ROSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

IV. Provider business mailing address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-251-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number200200790
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200200790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: