Provider Demographics
NPI:1013966514
Name:ROSEN, SCOTT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:IRA
Last Name:ROSEN
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 1:2031 HAY TERRACE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-252-8291
Mailing Address - Fax:610-252-7577
Practice Address - Street 1:2031 HAY TERRACE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-252-8291
Practice Address - Fax:610-252-7577
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041883L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149782Medicare ID - Type Unspecified
PAF40437Medicare UPIN