Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 28770 | WV |
NPI | 1760457675 |
---|---|
Provider Name | Dr. Paul Rosen |
First Address | Morgantown, WV 26506-1200 |
Second Address | Morgantown, WV 26501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100816400 | (05) | PA |
H80801 | (02) | PA |