Provider Demographics
NPI:1306837257
Name:ROSARIO, ANIBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ORIENTA AVE STE 1251
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6611
Mailing Address - Country:US
Mailing Address - Phone:407-339-2910
Mailing Address - Fax:321-972-3467
Practice Address - Street 1:745 ORIENTA AVE STE 1251
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6611
Practice Address - Country:US
Practice Address - Phone:407-339-2910
Practice Address - Fax:321-972-3467
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12081207R00000X
FLME128206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG67887Medicare UPIN
PR89558Medicare ID - Type UnspecifiedPROVIDER NUMBER