Provider Demographics
NPI:1659354082
Name:ROSEN, JAMES PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-232-9911
Mailing Address - Fax:860-233-5996
Practice Address - Street 1:836 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:860-233-5996
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021424207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
212201OtherPREFERRED ONE
P694441OtherOXFORD
00121424600OtherBLUE CROSS MEDICAID
010021424CT01OtherBLUE CROSS
OS2482OtherHEALTHNET & HEALTHNET MED
0445270002OtherCIGNA
051022OtherCONNECTICARE
P694441OtherOXFORD
010021424CT01OtherBLUE CROSS