Provider Demographics
NPI:1942280540
Name:ROSE, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
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 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-3174
Mailing Address - Fax:
Practice Address - Street 1:10 MEMBERS WAY STE 203
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-742-3174
Practice Address - Fax:603-742-1855
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3080014Medicaid
NH01YP04089NH01OtherANTHEM BLUE CROSS BLUE SH
NHH49813Medicare UPIN
NH01YP04089NH01OtherANTHEM BLUE CROSS BLUE SH