Provider Demographics
NPI:1114298239
Name:LEONARD A. ROSEN, MD., PC.
Entity Type:Organization
Organization Name:LEONARD A. ROSEN, MD., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:ASHER
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-655-9420
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-0400
Mailing Address - Country:US
Mailing Address - Phone:703-217-5800
Mailing Address - Fax:703-425-1211
Practice Address - Street 1:8701 DIGGES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4423
Practice Address - Country:US
Practice Address - Phone:571-655-9420
Practice Address - Fax:703-425-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty