Healthcare Provider Details

I. General information

NPI: 1225475155
Provider Name (Legal Business Name): DAVID ROBERT ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111
US

IV. Provider business mailing address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-6961
  • Fax:
Mailing address:
  • Phone: 216-476-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.133330
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA125015
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017008628
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35.133330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: