Provider Demographics
NPI:1275723074
Name:DEL ROSARIO, MA CLARISSA H (MD)
Entity Type:Individual
Prefix:DR
First Name:MA CLARISSA
Middle Name:H
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MA. CLARISSA
Other - Middle Name:H
Other - Last Name:DEL ROSARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-5504
Practice Address - Country:US
Practice Address - Phone:585-922-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245321207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02940870Medicaid
NYJ400056618Medicare UPIN