Provider Demographics
NPI:1114905106
Name:ROSSI, HUMBERTO ALFREDO (MD)
Entity Type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:ALFREDO
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUMBERTO
Other - Middle Name:A
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:305 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1926
Mailing Address - Country:US
Mailing Address - Phone:410-228-1541
Mailing Address - Fax:410-228-1542
Practice Address - Street 1:305 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1926
Practice Address - Country:US
Practice Address - Phone:410-228-1541
Practice Address - Fax:410-228-1542
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57430Medicare UPIN
7210Medicare ID - Type Unspecified