Provider Demographics
NPI:1790871804
Name:ROSE, MARK WIILIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WIILIAM
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:313 SPEEN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1538
Mailing Address - Country:US
Mailing Address - Phone:508-653-7311
Mailing Address - Fax:508-653-0549
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-653-7311
Practice Address - Fax:508-653-0549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1800213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70826OtherBLUE CROSS BLUE SHIELD
MA33122OtherHARVARD PILGRIM HEALTH CA
MA0361739Medicaid
MA001800OtherTUFTS MEDICARE PREFERRED
MA001800OtherTUFTS HEALTH PLAN
MA3818OtherFALLON
MAY70826OtherBLUE CROSS BLUE SHIELD
MA001800OtherTUFTS MEDICARE PREFERRED
MA3818OtherFALLON