Provider Demographics
NPI:1235540782
Name:RODEN, ROSEMARY CLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:CLAIRE
Last Name:RODEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:CLAIRE
Other - Last Name:RODEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:905 W GOVERNOR RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2307
Practice Address - Country:US
Practice Address - Phone:717-531-7235
Practice Address - Fax:717-531-0067
Is Sole Proprietor?:No
Enumeration Date:2014-05-17
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-128198208000000X, 2080P0204X
PAMD4677792080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103658019Medicaid