Provider Demographics
NPI:1770500290
Name:ROSE, JOAN HELENA (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:HELENA
Last Name:ROSE
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 1:233 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6543
Mailing Address - Country:US
Mailing Address - Phone:757-499-6400
Mailing Address - Fax:757-499-3322
Practice Address - Street 1:233 BUSINESS PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6543
Practice Address - Country:US
Practice Address - Phone:757-499-6400
Practice Address - Fax:757-499-3322
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010370412086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007320221Medicaid
00X808H77Medicare PIN