Healthcare Provider Details

I. General information

NPI: 1144294323
Provider Name (Legal Business Name): STEVEN MARK ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 OLD STREET RD SUITE B
TREVOSE PA
19053-6222
US

IV. Provider business mailing address

4979 OLD STREET RD SUITE B
TREVOSE PA
19053-6222
US

V. Phone/Fax

Practice location:
  • Phone: 267-288-5601
  • Fax: 267-288-5905
Mailing address:
  • Phone: 267-288-5601
  • Fax: 267-288-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD034707E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: