Provider Demographics
NPI:1336285261
Name:ROSEN, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 OLD ROSWELL LAKES PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1675
Mailing Address - Country:US
Mailing Address - Phone:770-545-8799
Mailing Address - Fax:631-824-9162
Practice Address - Street 1:800 OLD ROSWELL LAKES PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1675
Practice Address - Country:US
Practice Address - Phone:770-545-8799
Practice Address - Fax:631-824-9162
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2016-03-18
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Provider Licenses
StateLicense IDTaxonomies
NY179918-1207R00000X
NY1799182084P0800X
GA0338862084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336285261Medicare NSC
NY1336285261Medicare NSC