Provider Demographics
NPI:1285661439
Name:MCBRIDE, ROSALIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:L
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:2405 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1417
Practice Address - Country:US
Practice Address - Phone:574-524-7575
Practice Address - Fax:574-524-7576
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042699207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000082178OtherANTHEM BLUE CROSS
IN15836OtherPHYSICIANS HEALTH PLAN
IN200030450Medicaid
IN160047876Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ING02115Medicare UPIN
IN000000082178OtherANTHEM BLUE CROSS