1245261692 NPI number — MRS. SONIA JOSHI ROSE O.D.

Table of content: MRS. SONIA JOSHI ROSE O.D. (NPI 1245261692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245261692 NPI number — MRS. SONIA JOSHI ROSE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
SONIA
Provider Middle Name:
JOSHI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOSHI
Provider Other First Name:
SONIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245261692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12100 KENNEDY LANE
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-785-3937
Provider Business Mailing Address Fax Number:
540-785-5498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12100 KENNEDY LANE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-785-3937
Provider Business Practice Location Address Fax Number:
540-785-5498
Provider Enumeration Date:
07/05/2006

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: 152W00000X , with the licence number:  0618001502 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101258324 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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