Provider Demographics
NPI:1255327771
Name:ROSEMAN, JOHN C JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:ROSEMAN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MARION AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-837-2700
Mailing Address - Fax:330-837-2707
Practice Address - Street 1:323 MARION AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-837-2700
Practice Address - Fax:330-837-2707
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2640213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795555Medicaid
U08684Medicare UPIN
OH0795555Medicaid