Provider Demographics
NPI:1801126370
Name:BRENT ROSEN, D.O., LLC
Entity type:Organization
Organization Name:BRENT ROSEN, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:610-930-9900
Mailing Address - Street 1:401 HYDE PARK
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-6619
Mailing Address - Country:US
Mailing Address - Phone:267-247-5345
Mailing Address - Fax:267-247-5375
Practice Address - Street 1:401 HYDE PARK
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-6619
Practice Address - Country:US
Practice Address - Phone:267-247-5345
Practice Address - Fax:267-247-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177386Medicare PIN