Provider Demographics
NPI:1053302273
Name:ROSE, DIANE LORIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LORIA
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2221 CLEARVIEW PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2458
Mailing Address - Country:US
Mailing Address - Phone:504-885-8363
Mailing Address - Fax:504-885-1005
Practice Address - Street 1:2221 CLEARVIEW PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2458
Practice Address - Country:US
Practice Address - Phone:504-885-8363
Practice Address - Fax:504-885-1005
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD10473R207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA49048Medicaid
LA49048Medicaid
G08546Medicare UPIN