Provider Demographics
NPI:1871525568
Name:ROSEN, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4136
Mailing Address - Country:US
Mailing Address - Phone:240-777-3999
Mailing Address - Fax:240-777-4263
Practice Address - Street 1:2000 DENNIS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4136
Practice Address - Country:US
Practice Address - Phone:240-777-3999
Practice Address - Fax:240-777-4263
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076310207RI0200X
DC035689207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00678661OtherMEDICARE RAILROAD
DCP00678661OtherMEDICARE RAILROAD