Provider Demographics
NPI:1629029665
Name:ROSE, GEORGE S II (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:ROSE
Suffix:II
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 1:3625 N ELM ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2604
Mailing Address - Country:US
Mailing Address - Phone:336-282-4840
Mailing Address - Fax:336-282-4660
Practice Address - Street 1:3625 N ELM ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2604
Practice Address - Country:US
Practice Address - Phone:336-282-4840
Practice Address - Fax:336-282-4660
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134JAOtherBCBS
NC89134JAMedicaid
NC2017969Medicare ID - Type Unspecified
H88575Medicare UPIN