Provider Demographics
NPI:1013062991
Name:ROSEN, BRUCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:22 CEDAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ROSE VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6719
Mailing Address - Country:US
Mailing Address - Phone:610-566-4964
Mailing Address - Fax:
Practice Address - Street 1:431 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-2401
Practice Address - Country:US
Practice Address - Phone:610-237-6300
Practice Address - Fax:610-586-2927
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019565E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31936Medicare UPIN
PA149442Medicare ID - Type Unspecified