Provider Demographics
NPI:1063510576
Name:ROSSINI, MICHAEL V (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:ROSSINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PENNCRAFT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1649
Mailing Address - Country:US
Mailing Address - Phone:717-263-1383
Mailing Address - Fax:717-263-7434
Practice Address - Street 1:25 PENNCRAFT AVE STE E
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1649
Practice Address - Country:US
Practice Address - Phone:717-263-1383
Practice Address - Fax:717-263-7434
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD446102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD159041300Medicaid
PA1031500690001Medicaid
300035218Medicare PIN
MDKN77KM14Medicare PIN
PA1031500690001Medicaid
300035217Medicare PIN
MD159041300Medicaid