Individual
DR. COLIN A ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
202 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
(304) 645-4043
(304) 645-4713
Mailing address
PO BOX 671, LEWISBURG, WV 24901-0671
(304) 645-4043
(304) 645-4713
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17710
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722063
MTN STATE BCBS
WV
01
—
010097983
FEDERAL WKRS COMP/BL
WV
05
—
0120309000
—
WV
01
—
1058352
WV WORKERS COMP
WV
01
—
288546
MAMSI
WV
01
—
300126637
RAILROAD MCARE
WV
01
—
462502
ANTHEM BCBS
—
01
—
55073865301
CHAMPUS
—
Enumeration date
10/26/2006
Last updated
11/14/2008
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