Active NPI
Roberta F Rose, M.D.
- Rheumatology Physician
- Norwalk, CT
National Provider Identifier
1336131085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 034575
- Practice address
- 40 Cross St
4TH FL
Norwalk, CT 06851-4647 - Phone
- (203) 845-4800
- Fax
- (203) 845-4871
- NPI assigned
- Aug 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 034575 | CT | |
| Rheumatology Physician | 207RR0500X | 034575 | CT | Primary |
Addresses
Primary practice location
40 Cross St
4TH FL
Norwalk, CT 06851-4647
Mailing address
761 Main Ave Ste 112
Norwalk, CT 06851-1080
Phone (203) 852-2290
Other practice location 1
761 Main Ave Ste 112
Norwalk, CT 06851-1080
Phone (203) 852-2290
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001345752 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034575 | CT | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548201600000",
"number": "1336131085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "761 MAIN AVE STE 112",
"city": "NORWALK",
"state": "CT",
"postal_code": "068511080",
"telephone_number": "203-852-2290",
"fax_number": "203-899-5029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 CROSS ST",
"address_2": "4TH FL",
"city": "NORWALK",
"state": "CT",
"postal_code": "068514647",
"telephone_number": "203-845-4800",
"fax_number": "203-845-4871"
}
],
"practiceLocations": [
{
"address_1": "761 Main Ave Ste 112",
"address_purpose": "LOCATION",
"city": "Norwalk",
"state": "CT",
"postal_code": "068511080",
"country_code": "US",
"telephone_number": "203-852-2290",
"fax_number": "203-899-5029",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROSE",
"first_name": "ROBERTA",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-18",
"last_updated": "2019-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "034575",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "CT",
"license": "034575",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001345752",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Norwalk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.