Provider Demographics
NPI:1780804062
Name:ROBERT T. ROSEN, M.D
Entity type:Organization
Organization Name:ROBERT T. ROSEN, M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-359-5454
Mailing Address - Street 1:1102 KINGWOOD DR STE 204
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3009
Mailing Address - Country:US
Mailing Address - Phone:281-359-5454
Mailing Address - Fax:281-359-5415
Practice Address - Street 1:1102 KINGWOOD DR STE 204
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3009
Practice Address - Country:US
Practice Address - Phone:281-359-5454
Practice Address - Fax:281-359-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00148QMedicare ID - Type Unspecified
TXD35924Medicare UPIN