Provider Demographics
NPI:1194204701
Name:ROSE, CARLY BERNSTEIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:BERNSTEIN
Last Name:ROSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 WORCESTER ST STE 95
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3737
Mailing Address - Country:US
Mailing Address - Phone:774-344-4046
Mailing Address - Fax:857-999-3940
Practice Address - Street 1:888 WORCESTER ST STE 95
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3737
Practice Address - Country:US
Practice Address - Phone:774-344-4046
Practice Address - Fax:857-999-3940
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6704207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology