Provider Demographics
NPI:1104121037
Name:ROSAN, JAY RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:RICHARD
Last Name:ROSAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 EVANS ROAD
Mailing Address - Street 2:PO BOX 525
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0525
Mailing Address - Country:US
Mailing Address - Phone:215-237-1800
Mailing Address - Fax:215-643-6488
Practice Address - Street 1:1244 FORT WASHINGTON AVE
Practice Address - Street 2:FAMILY PRACTICE OF UPPER DUBLIN
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-237-1800
Practice Address - Fax:215-643-6488
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003063 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine