Provider Demographics
NPI:1083046403
Name:ROSARIO, JENNIFER MAGDALENA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAGDALENA
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2489 SOMERSET BLVD
Mailing Address - Street 2:APT 213
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4003
Mailing Address - Country:US
Mailing Address - Phone:646-671-2779
Mailing Address - Fax:
Practice Address - Street 1:800 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-1000
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011034252080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine