Provider Demographics
NPI:1720075575
Name:KING, ROSE HUPALA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:HUPALA
Last Name:KING
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 1:332 WASHINGTON ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-235-7730
Mailing Address - Fax:781-235-7739
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:SUITE 275
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-235-7730
Practice Address - Fax:781-235-7739
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0142131Medicaid
2215865OtherCIGNA
205531OtherTUFTS
204133OtherHDHC
30189OtherBMC HEALTHNET
KIJ23844OtherBLUE CROSS
54066OtherFALLON
2607789OtherAETNA
J23844OtherBLUE CROSS
2607789OtherAETNA