Healthcare Provider Details

I. General information

NPI: 1285816843
Provider Name (Legal Business Name): LAWRENCE H ROSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E MCGOVERN AVE
LANCASTER PA
17602-1923
US

IV. Provider business mailing address

24 E MCGOVERN AVE
LANCASTER PA
17602-1923
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-2377
  • Fax: 717-509-9858
Mailing address:
  • Phone: 717-560-2377
  • Fax: 717-509-9858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC-002898-L
License Number StatePA

VIII. Authorized Official

Name: LAWRENCE H ROSEN
Title or Position: PODIATRIST
Credential: DPM
Phone: 717-509-7044