Provider Demographics
NPI:1336179191
Name:ROSEN, ROGER CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CRAIG
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 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3063
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3063
Practice Address - Country:US
Practice Address - Phone:508-775-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA530272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA230000567OtherRR MEDICARE
MA29059OtherHARVARD PILGRIM HEALTHCAR
MA722914OtherTUFTS MEDICARE PREFERRED
MA17-01032OtherUNITED HEALTHCARE
MA6177735Medicaid
MAJ03236OtherBCBS
MA6177735Medicaid
MA722914OtherTUFTS MEDICARE PREFERRED