Provider Demographics
NPI:1871551275
Name:ROSE, ABIGAIL L (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 QUAKERBRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4779
Mailing Address - Country:US
Mailing Address - Phone:609-528-9150
Mailing Address - Fax:609-528-9151
Practice Address - Street 1:300 WITHERSPOON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3401
Practice Address - Country:US
Practice Address - Phone:609-303-4600
Practice Address - Fax:609-303-4601
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227249207Q00000X
NJ25MA08287200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141381Medicaid