Provider Demographics
NPI:1619931672
Name:ROSEN, MICHAEL STUART (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STUART
Last Name:ROSEN
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 1:795 E MARSHALL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4400
Mailing Address - Country:US
Mailing Address - Phone:610-692-4666
Mailing Address - Fax:610-692-8261
Practice Address - Street 1:795 E MARSHALL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-692-4666
Practice Address - Fax:610-692-8261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024177E207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2533691OtherAETNA
PA084229OtherHIGHMARK
1151689007OtherCIGNA
PA46674OtherKEYSTONE MERCY
PA0008586860001Medicaid
0026138000OtherKEYSTONE HEALTH PLAN EAST
PA084229OtherHIGHMARK
084229Medicare ID - Type Unspecified