Provider Demographics
NPI:1477795102
Name:ROSE, ROSEMARIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:D
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MARTHA CUSTIS DR STE C1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2040
Mailing Address - Country:US
Mailing Address - Phone:703-671-2700
Mailing Address - Fax:703-671-7007
Practice Address - Street 1:1225 MARTHA CUSTIS DR STE C1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2040
Practice Address - Country:US
Practice Address - Phone:703-671-2700
Practice Address - Fax:703-671-7007
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine