Provider Demographics
NPI:1053339606
Name:ROSE, MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BONDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE C140
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-587-2500
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:3700 SUNSET LN
Practice Address - Street 2:SUITE 6
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6199
Practice Address - Country:US
Practice Address - Phone:925-755-8500
Practice Address - Fax:925-755-8200
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07624600208000000X
CAA112131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
60011948OtherHORIZON NJ HEALTH
60011957OtherHORIZON NJ HEALTH
7588624OtherAETNA PPO
11341226OtherCAQH
9410411OtherPHCS
60011952OtherHORIZON NJ HEALTH
60011954OtherHORIZON NJ HEALTH
3682036OtherAETNA HMO