Provider Demographics
NPI:1851351951
Name:ROSE, DONALD R JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:ROSE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-765-0020
Mailing Address - Fax:336-765-0581
Practice Address - Street 1:755 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7106
Practice Address - Country:US
Practice Address - Phone:336-765-0020
Practice Address - Fax:336-765-0581
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9600712207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891068HMedicaid
VA1851351951Medicaid
NC2236227EMedicare PIN
NC891068HMedicaid
VA1851351951Medicaid