1699919134 NPI number — HAROLD A. ROSENE

Table of content: HAROLD A. ROSENE (NPI 1699919134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699919134 NPI number — HAROLD A. ROSENE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENE
Provider First Name:
HAROLD
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSENE
Provider Other First Name:
HAROLD
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699919134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HARBOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04554-0499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-677-3138
Provider Business Mailing Address Fax Number:
207-677-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 HARRINGTON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMAQUID
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-677-3138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  005290 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)