Provider Demographics
NPI:1730527342
Name:ROSE, ROBERT M (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1041 SHARON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:KING WILLIAM
Mailing Address - State:VA
Mailing Address - Zip Code:23086-3344
Mailing Address - Country:US
Mailing Address - Phone:804-769-3096
Mailing Address - Fax:804-769-3170
Practice Address - Street 1:1041 SHARON RD STE 205
Practice Address - Street 2:
Practice Address - City:KING WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:23086-3344
Practice Address - Country:US
Practice Address - Phone:804-769-3096
Practice Address - Fax:804-769-3170
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101259659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05698OtherGROUP PTAN