Provider Demographics
NPI:1073539516
Name:ROUSOU, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ROUSOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1619
Practice Address - Country:US
Practice Address - Phone:413-794-5550
Practice Address - Fax:413-794-4212
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42003208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16060OtherHEALTH NEW ENGLAND
MAN51689OtherBLUE CROSS OF MA
MA300079OtherHARVARD PILGRIM
MAB99130Medicare UPIN
MA0013239OtherNEIGHBORHOOD HEALTH PLAN
MA484117OtherCONNECTICARE
MA000000023448OtherBMC-HEALTHNET
MA330001975OtherRAILROAD MEDICARE
MA2058804Medicaid
MA042003OtherTUFTS
MAN51689Medicare PIN