Healthcare Provider Details

I. General information

NPI: 1689051013
Provider Name (Legal Business Name): MERYL ROSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

IV. Provider business mailing address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-1196
  • Fax:
Mailing address:
  • Phone: 267-273-1196
  • Fax: 267-273-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD466726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: