Provider Demographics
NPI:1184810657
Name:ROSE, NATASHA EADDY (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:EADDY
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:PO BOX 841706
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0021
Mailing Address - Country:US
Mailing Address - Phone:281-412-0955
Mailing Address - Fax:281-412-0956
Practice Address - Street 1:3827 ADDISON DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3023
Practice Address - Country:US
Practice Address - Phone:281-412-0955
Practice Address - Fax:281-412-0956
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7155208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189053501Medicaid
TX8K0801Medicare PIN