Provider Demographics
NPI:1144294323
Name:ROSEN, STEVEN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
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 1:4979 OLD STREET RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6222
Mailing Address - Country:US
Mailing Address - Phone:267-288-5601
Mailing Address - Fax:267-288-5905
Practice Address - Street 1:4979 OLD STREET RD
Practice Address - Street 2:SUITE B
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6222
Practice Address - Country:US
Practice Address - Phone:267-288-5601
Practice Address - Fax:267-288-5905
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034707E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0160788000OtherKEYSTONE INDIVIDUAL
PA232749589OtherHEALTHNET/TRICARE
PA5561325OtherUSHC GROUP
PA4239977OtherUSHC INDIVIDUAL
PA0698266000OtherKEYSTONE GROUP
PA0698266000OtherAMERIHEALTH GROUP
PA0160788000OtherAMERIHEALTH INDIVIDUAL
PAP1778140OtherOXFORD
PA0000755415OtherBLUE CROSS GROUP
PA9598079001OtherCIGNA
PA9598079001OtherCIGNA
PA0160788000OtherKEYSTONE INDIVIDUAL
NJ082768S4EMedicare ID - Type UnspecifiedNJ MEDICARE INDIVIDUAL
PAD71666Medicare UPIN
PA000755415Medicare ID - Type UnspecifiedMEDICARE PA GROUP