Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 35090446 | OH |
N | 2080P0203X | Pediatric Critical Care Doctor | 35090446 | OH |
NPI | 1134176118 |
---|---|
Provider Name | Kerry L Rosen |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2774298 | (05) | OH |
3810009905 | WV MEDICAID (01) | OH |
7100022060 | KY MEDICAID (01) | OH |
RO4218851 | MEDICARE OHIO (01) | |
RO4262091 | MEDICARE (01) | OH |