Healthcare Provider Details

I. General information

NPI: 1538105978
Provider Name (Legal Business Name): ROBERT JOHN ROSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR SECTION OF PAIN MEDICINE
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-6040
  • Fax:
Mailing address:
  • Phone: 603-650-6040
  • Fax: 603-650-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4497
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: