Provider Demographics
NPI:1235441791
Name:SIOCO, JOSE LEONARDO ROSALES III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE LEONARDO
Middle Name:ROSALES
Last Name:SIOCO
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8109 TIS WELL DRIVE
Practice Address - Street 2:SUITE 511
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-799-9500
Practice Address - Fax:703-799-9502
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2021-08-23
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Provider Licenses
StateLicense IDTaxonomies
ORMD162200207Q00000X
VA0101272474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine