Provider Demographics
NPI:1184677924
Name:ROSSER, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ROSSER
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:105 W STONE DR STE 2C
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-378-7679
Practice Address - Fax:423-378-7679
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233222207RP1001X
TN12584207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006090656OtherVIRGINIA MEDICAID
TN5824025OtherAETNA
TN62134825604OtherJOHN DEERE HEALTHCARE
KY64747850OtherKENTUCKY MEDICAID
TN100022749OtherPHP TENN CARE
TN1738771OtherUNITED HEALTHCARE
VA055801OtherANTHEM
TN3180728Medicaid
TN0001676OtherBLUE CROSS BLUE SHIELD
TN1738771OtherUNITED HEALTHCARE
VAC05950Medicare PIN
TN103I292866Medicare PIN
TN5824025OtherAETNA
B03923Medicare UPIN
VA016815P50Medicare PIN
VAV V3873BMedicare PIN
TN3180728Medicaid
TN3180720Medicare PIN
KY64747850OtherKENTUCKY MEDICAID
VA055801OtherANTHEM
TN0001676OtherBLUE CROSS BLUE SHIELD
TN62134825604OtherJOHN DEERE HEALTHCARE
TN103I292405Medicare PIN