Organization
BEAVERTOWN CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD J ROSE M.D. (PHYSICIAN)
(937) 294-2555
Entity
Organization
Contact information
Practice address
3017 WILMINGTON PIKE, KETTERING, OH 45429-4169
(937) 294-2555
(937) 294-3211
Mailing address
3017 WILMINGTON PIKE, KETTERING, OH 45429-4169
(937) 294-2555
(937) 294-3211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35052219R
OH
207Q00000X
Family Medicine Physician
35058825R
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R00609981
—
OH
Enumeration date
07/07/2005
Last updated
02/23/2010
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