Provider Demographics
NPI:1114985421
Name:ROSARIO, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:ROSARIO
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:# L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-6453
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-7960
Practice Address - Fax:740-382-6469
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059997R207X00000X
OH35.059997207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795117Medicaid
353077OtherSUBMITTER NO
0901261OtherUHC
2153652OtherAETNA
000000118422OtherANTHEM
353077OtherSUBMITTER NO
0901261OtherUHC
2153652OtherAETNA
OH0795117Medicaid
0901261OtherUHC
2153652OtherAETNA
OH0880441Medicare PIN
OH000000118422OtherANTHEM
311098079OtherCIGNA
311098079OtherTAX ID