MEDICARE: DR. MARVIN - ROSEN 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	2084P0804X	Child & Adolescent Psychiatry Physician	8156	OR

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	:	1881602985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN - ROSEN M.D.

Provider Business Mailing Address
First Line	:	6663 SW BEAVERTON HILLSDALE HWY PMB #291
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-1403
Country	:	US
Telephone Number	:	503-396-6661
Fax Number	:	503-296-6661

Provider Business Practice Location Address
First Line	:	131 NE 102ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-4167
Country	:	US
Telephone Number	:	503-253-6754
Fax Number	:	503-253-8020

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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