Provider Demographics
NPI:1164409793
Name:ROSEN, PATRICIA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:BETH
Last Name:ROSEN
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 1:3303 NORTHLAND DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3303 NORTHLAND DR
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4945
Practice Address - Country:US
Practice Address - Phone:512-371-8822
Practice Address - Fax:512-371-8840
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2767207PT0002X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB62083Medicare UPIN