Provider Demographics
NPI:1306888201
Name:ROSE, STUART R (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:R
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2439
Mailing Address - Country:US
Mailing Address - Phone:800-355-0808
Mailing Address - Fax:610-834-2862
Practice Address - Street 1:115 W SILVER ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3628
Practice Address - Country:US
Practice Address - Phone:413-568-2811
Practice Address - Fax:610-834-2862
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34965207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000032860OtherBMC HEALTH NET
MA2024861Medicaid
MA16007OtherHEALTHCARE NEW ENGLAND
MA930085934OtherRAILROAD MEDICARE
MAROG01034OtherBLUE SHIELD
MAG01034Medicare ID - Type Unspecified
MAB74024Medicare UPIN