Healthcare Provider Details

I. General information

NPI: 1891054953
Provider Name (Legal Business Name): RYAN A ROSE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.018513
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO176924
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: