Provider Demographics
NPI:1134163553
Name:ROSE, RICHARD HARLOWE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARLOWE
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST STE 440
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4093
Mailing Address - Country:US
Mailing Address - Phone:828-580-4334
Mailing Address - Fax:828-580-4702
Practice Address - Street 1:2209 S STERLING ST STE 440
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4093
Practice Address - Country:US
Practice Address - Phone:828-580-4334
Practice Address - Fax:828-580-4702
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02460208800000X
NY152168208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134163553Medicaid