Provider Demographics
NPI:1407882483
Name:ROSEN, HAROLD HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:HARVEY
Last Name:ROSEN
Suffix:
Gender:M
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:ONE WEST SAMPLE ROAD
Mailing Address - Street 2:STE 102
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-782-2442
Mailing Address - Fax:954-782-2502
Practice Address - Street 1:ONE WEST SAMPLE ROAD
Practice Address - Street 2:STE 102
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-782-2442
Practice Address - Fax:954-782-2502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032990207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049047400Medicaid
D63103Medicare UPIN
94034Medicare ID - Type Unspecified