Provider Demographics
NPI:1891750154
Name:ROSE, DAVID MILTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILTON
Last Name:ROSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1239
Mailing Address - Country:US
Mailing Address - Phone:215-575-9577
Mailing Address - Fax:215-563-7976
Practice Address - Street 1:321 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1239
Practice Address - Country:US
Practice Address - Phone:215-575-9577
Practice Address - Fax:215-563-7976
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001355L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050232Medicare ID - Type Unspecified
PA48622Medicare ID - Type Unspecified
PAT27576Medicare UPIN