Provider Demographics
NPI:1003863119
Name:MAGNESS, ROSE L (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:L
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 HADDONFIELD BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3736
Mailing Address - Country:US
Mailing Address - Phone:856-795-3313
Mailing Address - Fax:856-354-8780
Practice Address - Street 1:1810 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3736
Practice Address - Country:US
Practice Address - Phone:856-795-3313
Practice Address - Fax:856-354-8780
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05303200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF05937Medicare UPIN