Provider Demographics
NPI:1407892177
Name:ROSEN, CLIFFORD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:JAMES
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 1:81 RESEARCH DR
Mailing Address - Street 2:MAINE MEDICAL CENTER RESEARCH INSTITUTE
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8228
Mailing Address - Fax:207-885-8174
Practice Address - Street 1:81 RESEARCH DR
Practice Address - Street 2:MAINE MEDICAL CENTER RESEARCH INSTITUTE
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-396-8228
Practice Address - Fax:207-885-8174
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED03841Medicare UPIN
ME11695301Medicare PIN
ME116953Medicare ID - Type Unspecified