Provider Demographics
NPI:1932605383
Name:ROSE, MARA FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:FRANCES
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:310 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9411
Mailing Address - Country:US
Mailing Address - Phone:910-599-0084
Mailing Address - Fax:910-399-2190
Practice Address - Street 1:311 JUDGES RD STE 4E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:910-399-2190
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC211251207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine