Provider Demographics
NPI:1548235849
Name:ROSE, MEREDITH B (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:B
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5320 PROVIDENCE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-413-7600
Mailing Address - Fax:757-413-7601
Practice Address - Street 1:5320 PROVIDENCE RD
Practice Address - Street 2:STE 301
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-413-7600
Practice Address - Fax:757-413-7601
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-12-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101031120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005610257Medicaid
VA005610257Medicaid
B05622Medicare UPIN