Provider Demographics
NPI:1629338231
Name:ROSE, VICTORIA SUMMER (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SUMMER
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 ROUTE 47 UNIT G
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1411
Mailing Address - Country:US
Mailing Address - Phone:609-886-5245
Mailing Address - Fax:609-886-5873
Practice Address - Street 1:1613 ROUTE 47 UNIT G
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242
Practice Address - Country:US
Practice Address - Phone:609-886-5245
Practice Address - Fax:609-886-5873
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453908207Q00000X
390200000X
NJ25MA10581300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program