Provider Demographics
NPI:1497796064
Name:ROSEN, BARRY (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:MSC 9152
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010104972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000231026OtherUNISON
OH7253591OtherAETNA
KY000000329584OtherBCBS PROVIDER NUMBER
OH000000550692OtherANTHEM
OH0304914OtherBCMH
OH2362232Medicaid
KY64059082Medicaid
OH752764OtherBUCKEYE
OH752764OtherBUCKEYE
OH0304914OtherBCMH
F03730Medicare UPIN
KY0903619Medicare PIN
OH000000550692OtherANTHEM
OH7253591OtherAETNA