Provider Demographics
NPI:1336115153
Name:ROSANELLI, EDWARD GEORGE JR (M D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GEORGE
Last Name:ROSANELLI
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4129 N. ARMENIA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-875-3884
Mailing Address - Fax:813-878-2355
Practice Address - Street 1:4129 N. ARMENIA AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-875-3884
Practice Address - Fax:813-878-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME29113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01299598OtherRAILROAD MEDICARE PIN - PTAN
FL039794600Medicaid
FL039794600Medicaid
FLP01299598OtherRAILROAD MEDICARE PIN - PTAN