Provider Demographics
NPI:1861504078
Name:ROSE, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
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 1:7 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6130
Mailing Address - Country:US
Mailing Address - Phone:603-447-3500
Mailing Address - Fax:603-447-5568
Practice Address - Street 1:7 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6130
Practice Address - Country:US
Practice Address - Phone:603-447-3500
Practice Address - Fax:603-447-5568
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7160207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0107510Y0NH01OtherANTHEM BCBS
NH30009483Medicaid
NH408800OtherCIGNA
NH0107510Y0NH01OtherANTHEM BCBS
NH408800OtherCIGNA