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General NPI Number Information
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NPI Number | 1588832554
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Entity Type | Organization
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Legal Business Name | DR. MARK ROSE DPM
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 67 UNION ST STE 304
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 617-361-9776
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Fax | 617-361-1254
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Provider Business Mailing Address
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Address Line | 67 UNION ST STE 304
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 617-361-9776
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Fax | 617-361-1254
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Authorized Official
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Title or Position | OWNER
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Name | MARK ROSE
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Credential | DPM
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Telephone | 617-361-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1800
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License Number State | MA
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