Provider Demographics
NPI:1407985864
Name:ROSE, KATHARINE JUDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:JUDSON
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHARINE
Other - Middle Name:ANN
Other - Last Name:JUDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:218 FRIEDRICHS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4517
Mailing Address - Country:US
Mailing Address - Phone:504-434-2330
Mailing Address - Fax:504-885-0820
Practice Address - Street 1:3305 METAIRIE RD STE 1
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5215
Practice Address - Country:US
Practice Address - Phone:504-434-2330
Practice Address - Fax:504-885-0820
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine