Provider Demographics
NPI:1689051013
Name:ROSEN, MERYL (MD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:
Last Name:ROSEN
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 1:1528 WALNUT ST STE 950
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3628
Mailing Address - Country:US
Mailing Address - Phone:267-273-1196
Mailing Address - Fax:267-273-1193
Practice Address - Street 1:1528 WALNUT ST STE 950
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3628
Practice Address - Country:US
Practice Address - Phone:267-273-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology