Provider Demographics
NPI:1982760724
Name:ROSA, EDWARD P (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5451 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4641
Mailing Address - Country:US
Mailing Address - Phone:954-757-7672
Mailing Address - Fax:954-757-7670
Practice Address - Street 1:5451 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4641
Practice Address - Country:US
Practice Address - Phone:954-757-7672
Practice Address - Fax:954-757-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME716172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111117OtherAMERIGROUP
FL152284OtherVALUE OPTIONS
FL41672OtherBSBC
FL5388461OtherAETNA PPO
FL7351806OtherGHI
FL96273OtherUNITED BEHAVIORAL
FLCOMPSYCHOther259896
1086806OtherAETNA HMO
FL299334OtherHARMONY
FLBENESIGHTOther41672
FL41672OtherBSBC
FL41672FMedicare ID - Type Unspecified