Provider Demographics
NPI:1609848118
Name:ROSEN, MELISSA S (MD)
Entity type:Individual
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First Name:MELISSA
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1650 UNIVERSITY BLVD NE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1726
Mailing Address - Country:US
Mailing Address - Phone:505-272-8950
Mailing Address - Fax:505-272-3202
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-8950
Practice Address - Fax:505-272-3202
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NMMD2003-0785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI05237Medicare UPIN