Provider Demographics
NPI:1558331082
Name:ROSEN, JED STUART (MD)
Entity type:Individual
Prefix:
First Name:JED
Middle Name:STUART
Last Name:ROSEN
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 1:295 STONER AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5698
Mailing Address - Country:US
Mailing Address - Phone:410-876-4400
Mailing Address - Fax:
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-876-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52063401OtherBC/BS ID
MD8295OtherCAREFIRST BC/BS ID
MD182326OtherAETNA HMO ID
MD4330973OtherAETNA ID
MDW106OtherFEP / BLUE CHOICE
MD064181200Medicaid
MD225486OtherMAMSI
MD182326OtherAETNA HMO ID
MD064181200Medicaid