Physician Compare National (NPI:1205877875)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1205877875
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042350332
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091217000330
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROSEN
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TUFTS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1 WALLIS COURT
	Group Practice or individual's line 1 address
City	LEXINGTON
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	024215403
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7818624550
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M