Provider Demographics
NPI:1245419688
Name:ANTONIO J. DEL ROSARIO, M.D. INC.
Entity Type:Organization
Organization Name:ANTONIO J. DEL ROSARIO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-220-4188
Mailing Address - Street 1:6501 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3561
Mailing Address - Country:US
Mailing Address - Phone:614-220-4188
Mailing Address - Fax:614-220-4190
Practice Address - Street 1:849 HARMON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2411
Practice Address - Country:US
Practice Address - Phone:614-220-4188
Practice Address - Fax:614-220-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033390D305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168278Medicaid
OH0168278Medicaid
OHC01165Medicare UPIN