Healthcare Provider Details

I. General information

NPI: 1285691659
Provider Name (Legal Business Name): MICHAEL B ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 MONTGOMERY AVE FL 1
PENN VALLEY PA
19072-1541
US

IV. Provider business mailing address

509 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-2951
  • Fax:
Mailing address:
  • Phone: 610-828-7570
  • Fax: 610-941-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-042474-E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD042474E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD042474E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: