Individual
MARK D ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5486 INDIAN RIVER RD, VIRGINIA BEACH, VA 23464-5365
(757) 424-2490
(757) 523-0508
Mailing address
5486 INDIAN RIVER RD, VIRGINIA BEACH, VA 23464-5365
(757) 424-2490
(757) 523-0508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102201083
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000771
SENTARA OPTIMA
—
01
—
186500
TRIGON BC/BS
—
01
—
9447070
CIGNA
—
Enumeration date
06/14/2006
Last updated
04/01/2008
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