Provider Demographics
NPI:1750948824
Name:ROSE, CHELSI (DO)
Entity type:Individual
Prefix:
First Name:CHELSI
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHELSI
Other - Middle Name:
Other - Last Name:KWITOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-6828
Mailing Address - Fax:570-214-6840
Practice Address - Street 1:15 WESNER LN FL 1
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8023
Practice Address - Country:US
Practice Address - Phone:570-271-6828
Practice Address - Fax:570-214-6840
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024825208000000X
TXT9490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116032911OtherMEDICAL TRAINING LICENSE