Provider Demographics
NPI:1164442174
Name:ROSMUS, STEPHEN MARION (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARION
Last Name:ROSMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-468-5641
Mailing Address - Fax:802-468-2923
Practice Address - Street 1:275 ROUTE 30 N
Practice Address - Street 2:CASTLETON FAMILY HEALTH CENTER
Practice Address - City:BOMOSEEN
Practice Address - State:VT
Practice Address - Zip Code:05732-9647
Practice Address - Country:US
Practice Address - Phone:802-468-5641
Practice Address - Fax:802-468-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT0420006152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007984Medicaid
VT0007984Medicaid
VT0007984Medicaid