Provider Demographics
NPI:1073043139
Name:ROSERO LLERENA, CHRISTIAN IVAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:IVAN
Last Name:ROSERO LLERENA
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 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5000
Mailing Address - Fax:
Practice Address - Street 1:764 KENNEDY ST STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2209
Practice Address - Country:US
Practice Address - Phone:814-373-2195
Practice Address - Fax:814-373-2197
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD477589207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease