Provider Demographics
NPI:1821193277
Name:ROSEN, NOAH A (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:A
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 RESEARCH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6228
Mailing Address - Country:US
Mailing Address - Phone:203-210-6340
Mailing Address - Fax:203-502-2615
Practice Address - Street 1:35 WELLS ST UNIT 3
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2962
Practice Address - Country:US
Practice Address - Phone:401-315-9575
Practice Address - Fax:401-315-9580
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA208758208600000X, 2086S0129X
CT746352086S0129X
RIMD193522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074056/AMedicaid
MA110074056/AMedicaid
A41069Medicare UPIN