Provider Demographics
NPI:1417006842
Name:ROSEN, LEONARD ASHER (MD,FACOG)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:ASHER
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD,FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-0400
Mailing Address - Country:US
Mailing Address - Phone:703-690-2295
Mailing Address - Fax:
Practice Address - Street 1:8701 DIGGES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4423
Practice Address - Country:US
Practice Address - Phone:571-655-9420
Practice Address - Fax:703-425-1211
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541163152OtherEIN
VAC62507Medicare UPIN