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General NPI Number Information
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NPI Number | 1861436289
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Entity Type | Individual
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Provider Name | PHILIP DAVID ROSE MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 801 GREEN VALLEY RD
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City | GREENSBORO
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State | NC
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Zip | 27408-7021
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Country | US
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Telephone | 336-832-6873
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13605
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City | GREENSBORO
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State | NC
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Zip | 27415-3605
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Country | US
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Telephone | 336-547-1877
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 200300189
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License Number State | NC
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