Provider Demographics
NPI:1962482786
Name:ROSE, CINDA BARNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:CINDA
Middle Name:BARNETT
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:4350 ALPHA RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4404
Practice Address - Country:US
Practice Address - Phone:972-404-9345
Practice Address - Fax:972-404-2506
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8963207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156560802Medicaid
TXH78633Medicare UPIN
TX8B1915Medicare ID - Type Unspecified
TX156560802Medicaid
TX8A4000Medicare PIN