Provider Demographics
NPI:1962416461
Name:ROSEN, DENNIS J (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:157 COLUMBIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-259-1777
Mailing Address - Fax:413-253-1507
Practice Address - Street 1:157 COLUMBIA DRIVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002
Practice Address - Country:US
Practice Address - Phone:413-259-1777
Practice Address - Fax:413-253-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA348222080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH10149Medicare ID - Type Unspecified
E02100Medicare UPIN