Provider Demographics
NPI:1285691659
Name:ROSEN, MICHAEL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444
Mailing Address - Country:US
Mailing Address - Phone:610-828-7570
Mailing Address - Fax:610-941-3915
Practice Address - Street 1:857 MONTGOMERY AVE FL 1
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1541
Practice Address - Country:US
Practice Address - Phone:601-664-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-042474-E207Q00000X
PAMD042474E207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP103OtherOXFORD
1015498OtherKEYSTONE MERCY
1332484OtherFIRST HEALTH NETWORK
1414084003OtherCIGNA
PA602157OtherPA BLUE SHIELD
0000001OtherAETNA HMO
PA0016144980001Medicaid
4226160OtherAETNA PPO
4226160OtherAETNA PPO
MOP103OtherOXFORD