Provider Demographics
NPI:1629059613
Name:ROSEN, ANDREW R (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
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 1:40 BUTTRICK RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3381
Mailing Address - Country:US
Mailing Address - Phone:603-552-1400
Mailing Address - Fax:603-552-1499
Practice Address - Street 1:40 BUTTRICK RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3381
Practice Address - Country:US
Practice Address - Phone:603-552-1400
Practice Address - Fax:603-552-1499
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11036207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHH28507OtherANTHEM REFERRING UPIN
NH0442517OtherUHC PIN
NH532720OtherCIGNA PIN
NH2431036OtherAETNA PIN
NH30200904Medicaid
NH990015343OtherRR MEDICARE PIN
NH01YP02564NH01OtherANTHEM ACES PIN
NHN1930OtherHPHC PIN
NH011036OtherTUFTS PIN
NHN1930OtherHPHC PIN
NH532720OtherCIGNA PIN