Individual
GINA L ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
17 IRON BRIDGE DR STE 150, COLLEGEVILLE, PA 19426-2042
(844) 622-6320
(484) 622-6337
Mailing address
PO BOX 789967, PHILADELPHIA, PA 19178-9967
(484) 622-7395
(484) 622-7399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD072494L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018651570003
—
PA
01
—
10935099
CAQH ID#
PA
01
—
1150744
KEYSTONE MERCY
PA
01
—
1313836
HIGHMARK BLUE SHIELD
PA
01
—
2007117000
IBC - PC/KHPE
PA
01
—
2635215
AETNA HMO
PA
01
—
7008842
CIGNA HMO/PPO
PA
01
—
7696259
AETNA PPO
PA
01
—
9201950
PHCS
PA
01
—
P00260461
RRM
PA
Enumeration date
06/09/2006
Last updated
06/05/2020
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