Provider Demographics
NPI:1124225719
Name:ANDREW P. ROSEN, M.D.
Entity type:Organization
Organization Name:ANDREW P. ROSEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-838-7940
Mailing Address - Street 1:1600 MEDICAL CENTER ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5002
Mailing Address - Country:US
Mailing Address - Phone:915-838-7940
Mailing Address - Fax:915-838-7808
Practice Address - Street 1:1600 MEDICAL CENTER ST
Practice Address - Street 2:SUITE 307
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:915-838-7940
Practice Address - Fax:915-838-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2287207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ2287OtherSTATE MEDICAL LICENSE
TX0096GEOtherBLUE CROSS BLUE SHIELD
TX147382901Medicaid
TXJ2287OtherSTATE MEDICAL LICENSE
TX00668QMedicare ID - Type Unspecified