MEDICARE: DR. DAVID S. ROSE PH.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	103TC0700X	Clinical Psychologist	2429	MD

General Provider Information

NPI Number	:	1710005038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S. ROSE PH.D.

Provider Business Mailing Address
First Line	:	1110 FIDLER LN
Second Line	:	SUITE 1417
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3425
Country	:	US
Telephone Number	:	301-587-5735
Fax Number	:	240-331-7190

Provider Business Practice Location Address
First Line	:	1110 FIDLER LN
Second Line	:	SUITE 1417
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3425
Country	:	US
Telephone Number	:	301-587-5735
Fax Number	:	240-331-7190

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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