Provider Demographics
NPI:1679663074
Name:ROSEN, LAWRENCE H (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:H
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E MCGOVERN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1923
Mailing Address - Country:US
Mailing Address - Phone:717-509-7044
Mailing Address - Fax:717-509-9858
Practice Address - Street 1:24 E MCGOVERN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-1923
Practice Address - Country:US
Practice Address - Phone:717-509-7044
Practice Address - Fax:717-509-9858
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002898-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30588Medicare UPIN
PA5275560001Medicare NSC