Provider Demographics
NPI:1619092202
Name:ROSE, JOHN PAUL (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:ROSE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1393 DAYSPRING DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9489
Mailing Address - Country:US
Mailing Address - Phone:610-366-0170
Mailing Address - Fax:
Practice Address - Street 1:ST LUKE'S HOSPITAL - CRITICAL CARE DIVISION
Practice Address - Street 2:801 OSTRUM STREET
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:610-954-2306
Practice Address - Fax:610-954-2220
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant