Provider Demographics
NPI:1629050463
Name:ROSEN, JOSEPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
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 1:21 BELMONT AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7110
Mailing Address - Country:US
Mailing Address - Phone:802-257-3751
Mailing Address - Fax:802-257-3754
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:SUITE1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-257-3751
Practice Address - Fax:802-257-3754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0838Medicaid
VT19652OtherBLUE CROSS/BLUE SHIELD
VTOVN0838Medicaid
OVN0838Medicare ID - Type Unspecified