Provider Demographics
NPI:1588657092
Name:ROSE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SUNNYBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3213
Mailing Address - Country:US
Mailing Address - Phone:610-323-5550
Mailing Address - Fax:610-327-4651
Practice Address - Street 1:20 SUNNYBROOK ROAD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3213
Practice Address - Country:US
Practice Address - Phone:610-323-5550
Practice Address - Fax:610-327-4651
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033294E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010126970003Medicaid
PA159583EH0Medicare ID - Type Unspecified
D71346Medicare UPIN