Provider Demographics
NPI:1437186129
Name:ROSE, ANDREW L (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11601 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1466
Mailing Address - Country:US
Mailing Address - Phone:804-717-5300
Mailing Address - Fax:804-748-7269
Practice Address - Street 1:11601 IRON BRIDGE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1466
Practice Address - Country:US
Practice Address - Phone:804-717-5300
Practice Address - Fax:804-748-7269
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258474OtherMAMSI
VA005630231Medicaid
VA5454581OtherAETNA HMO
VA7533015OtherCIGNA
VAC09633OtherGROUP PTAN
VA080121622OtherRAILROAD MEDICARE
VA43447OtherSENTARA
VA5454581OtherAETNA LIFE
VA333344OtherANTHEM BCBS OF VA
VA78955OtherSOUTHERN HEALTH SERVICES
080006381Medicare ID - Type Unspecified
VA333344OtherANTHEM BCBS OF VA