Provider Demographics
NPI:1205869104
Name:ROSEN, LAUREN S (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:306 E LANCASTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2105
Mailing Address - Country:US
Mailing Address - Phone:484-476-7255
Mailing Address - Fax:484-476-7854
Practice Address - Street 1:306 E LANCASTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2105
Practice Address - Country:US
Practice Address - Phone:484-476-7255
Practice Address - Fax:484-476-7854
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071702L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH46400Medicare UPIN
PA1026050100001Medicaid
PA050368HK1Medicare PIN