Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D54127 | MD |
NPI | 1093830846 |
---|---|
Provider Name | Dr. Karl A. Rose |
First Address | Potomac, MD 20854-2082 |
Second Address | Chevy Chase, MD 20815-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |