Provider Demographics
NPI:1801824578
Name:ROSE, GEOFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 OBSERVATORY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2231
Mailing Address - Country:US
Mailing Address - Phone:513-871-7673
Mailing Address - Fax:855-297-3389
Practice Address - Street 1:2753 OBSERVATORY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2231
Practice Address - Country:US
Practice Address - Phone:513-871-7673
Practice Address - Fax:855-297-3389
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2428162Medicaid
OHRO4115572Medicare PIN
OHH93489Medicare UPIN