Provider Demographics
NPI:1659568541
Name:ADAM R ROSEN, MD, PS
Entity Type:Organization
Organization Name:ADAM R ROSEN, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-889-5045
Mailing Address - Street 1:620 KIRKLAND WAY
Mailing Address - Street 2:200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6021
Mailing Address - Country:US
Mailing Address - Phone:425-889-5045
Mailing Address - Fax:
Practice Address - Street 1:620 KIRKLAND WAY
Practice Address - Street 2:200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-889-5045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000454822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty