Provider Demographics
NPI:1699702571
Name:KURIAKOSE, ROSALIE A (MD)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:A
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:740-845-7500
Mailing Address - Fax:740-845-7501
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1170
Practice Address - Country:US
Practice Address - Phone:740-845-7500
Practice Address - Fax:740-845-7501
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438857Medicaid
OH2438857Medicaid
H98721Medicare UPIN