Provider Demographics
NPI:1174571665
Name:ROSE, MAGDALENA (MD)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2567 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2018
Mailing Address - Country:US
Mailing Address - Phone:513-321-7673
Mailing Address - Fax:513-321-7676
Practice Address - Street 1:2567 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2018
Practice Address - Country:US
Practice Address - Phone:513-321-7673
Practice Address - Fax:513-321-7676
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2431238Medicaid
IN200477240Medicaid
KY64069487Medicaid
IN200477240Medicaid
KY00182005Medicare PIN
KY0969499Medicare PIN
H92148Medicare UPIN
KY3396875Medicare PIN
KY64069487Medicaid