Provider Demographics
NPI:1801188735
Name:BRAD ROSEN, DO LLC
Entity Type:Organization
Organization Name:BRAD ROSEN, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-515-6000
Mailing Address - Street 1:3 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2643
Mailing Address - Country:US
Mailing Address - Phone:301-515-6000
Mailing Address - Fax:301-515-6039
Practice Address - Street 1:3 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:301-515-6000
Practice Address - Fax:301-515-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH47195208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1801894985OtherPERSONAL NPI
MDG06160Medicare UPIN