Provider Demographics
NPI:1689659831
Name:ROSEN, LESLIE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:B
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:954-633-3387
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:954-633-3387
Practice Address - Fax:954-633-3217
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME36847207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96209OtherBCBS FL
FL068525901Medicaid
FL96209OtherBCBS FL
FL96209VMedicare PIN