Provider Demographics
NPI:1992852859
Name:DEVASIA, ROSE D (MD,MPH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:D
Last Name:DEVASIA
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:A
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-589-4856
Mailing Address - Fax:502-589-5093
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:STE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-589-4856
Practice Address - Fax:502-589-5093
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44163207RI0200X
KY36624207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease