Provider Demographics
NPI:1497840177
Name:ROSAS, HERMINIA DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMINIA
Middle Name:DIANA
Last Name:ROSAS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:149 13TH ST RM 2275
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2020
Mailing Address - Country:US
Mailing Address - Phone:617-726-0658
Mailing Address - Fax:617-724-1227
Practice Address - Street 1:15 PARKMAN STREET WAC 835
Practice Address - Street 2:NEUROLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-1728
Practice Address - Fax:617-724-1480
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-09-21
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Provider Licenses
StateLicense IDTaxonomies
MA1515742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA730034OtherTUFTS HEALTH PLAN
MA3165299Medicaid
MAJ17730OtherBCBS MA
MAJ17730OtherBCBS MA
MAA22402Medicare ID - Type Unspecified