Provider Demographics
NPI:1063502839
Name:ROSEN, FREDERICK S (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:S
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:PO BOX 6177
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6977
Mailing Address - Country:US
Mailing Address - Phone:925-463-0336
Mailing Address - Fax:925-463-1387
Practice Address - Street 1:1181 CENTRAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2252
Practice Address - Country:US
Practice Address - Phone:925-463-0336
Practice Address - Fax:925-463-1387
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84955207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84955OtherLICENSE
ZZZ21406ZOtherMEDICARE GR
00A849550Medicare ID - Type Unspecified
I11062Medicare UPIN