Provider Demographics
NPI:1083010714
Name:ROSSIP, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:ROSSIP
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 1:3278 DENVER AVE
Mailing Address - Street 2:OFC
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3278 DENVER AVE
Practice Address - Street 2:OFC
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1652
Practice Address - Country:US
Practice Address - Phone:209-725-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63068207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine