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General NPI Number Information
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NPI Number | 1104901347
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Entity Type | Individual
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Provider Name | COLIN A ROSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 202 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970-1334
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Country | US
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Telephone | 304-645-4043
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Fax | 304-645-4713
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Provider Business Mailing Address
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Address Line | PO BOX 671
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City | LEWISBURG
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State | WV
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Zip | 24901-0671
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Country | US
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Telephone | 304-645-4043
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Fax | 304-645-4713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 17710
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License Number State | WV
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