Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8749 | MA |
NPI | 1023099025 |
---|---|
Provider Name | Dr. Julius Myron Rosen |
First Address | Marblehead, MA 01945-2759 |
Second Address | Peabody, MA 01960-2910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0261467 | (05) | MA |
16099 | PILGRIM (01) | MA |
T56446 | (02) | MA |
X02478 | BCBS (01) | MA |