Provider Demographics
NPI:1902842883
Name:ROSE, DHARMA (DO)
Entity Type:Individual
Prefix:DR
First Name:DHARMA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GERIDHARMA OR DHARMA
Other - Middle Name:ROSE
Other - Last Name:DEFRESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MS, RPH, FAIHM
Mailing Address - Street 1:54699 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-8915
Mailing Address - Country:US
Mailing Address - Phone:406-745-0845
Mailing Address - Fax:406-204-3238
Practice Address - Street 1:54699 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-8915
Practice Address - Country:US
Practice Address - Phone:406-745-0845
Practice Address - Fax:833-918-2217
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-53457207Q00000X, 204D00000X, 208100000X
IN02001899204D00000X, 207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200977140AMedicaid
1518902881OtherBCBS MONTANA IDENTIFIER
MT1518902881Medicaid
IN200231530Medicaid
MT1902842883Medicaid
IN200977140AMedicaid
IN200977140AMedicaid
MTM400061682OtherPTAN - DHARMA ROSE