Provider Demographics
NPI:1255443073
Name:DE ROSE, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DE ROSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1251 SOUTH CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-820-6320
Mailing Address - Fax:610-820-8376
Practice Address - Street 1:1251 SOUTH CEDAR CREST BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-820-6320
Practice Address - Fax:610-820-8376
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059105L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
37935OtherGEISINGER HEALTH PLAN
180034175OtherRAILROAD MEDICARE
807324OtherFIRST PRIORITY HEALTH
PA001721980Medicaid
506554OtherAETNA
DE891352OtherHIGH MARK BLUE SHIELD
37935OtherGEISINGER HEALTH PLAN
PA891352Medicare ID - Type Unspecified