Provider Demographics
NPI:1407277577
Name:ROSE, GABRIEL DAVID
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:DAVID
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S HANSON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2920
Mailing Address - Country:US
Mailing Address - Phone:410-819-5696
Mailing Address - Fax:
Practice Address - Street 1:100 S HANSON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2920
Practice Address - Country:US
Practice Address - Phone:410-819-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851660823OtherHEALTH DEPARTMENT