MEDICARE: DR. LOUIS CHARLES ROSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	153790	NY
2	207XS0106X	Orthopaedic Hand Surgery Physician	153790	NY
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	153790	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285748541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS CHARLES ROSE M.D.

Provider Business Mailing Address
First Line	:	530 E 76TH ST APT 27G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3173
Country	:	US
Telephone Number	:	212-772-8706
Fax Number	:	718-409-0306

Provider Business Practice Location Address
First Line	:	3058 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5726
Country	:	US
Telephone Number	:	718-409-0500
Fax Number	:	718-409-0306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/25/2010

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