Provider Demographics
NPI:1639181712
Name:ROSEN, ANDREW PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PHILLIP
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:307
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5002
Mailing Address - Country:US
Mailing Address - Phone:915-838-7940
Mailing Address - Fax:915-838-7936
Practice Address - Street 1:1600 MEDICAL CENTER ST
Practice Address - Street 2:307
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:915-838-7940
Practice Address - Fax:915-838-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2287207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083QDOtherBLUE CROSS BLUE SHIELD
TX147382901Medicaid
TXJ2287OtherSTATE MEDICAL LICENSE
TX0083QDOtherBLUE CROSS BLUE SHIELD
TXH49288Medicare UPIN