Provider Demographics
NPI:1447211412
Name:ROSMAN, MARY PAT (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:ROSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:909 W 1 ST
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0268
Mailing Address - Country:US
Mailing Address - Phone:563-578-3244
Mailing Address - Fax:563-578-3247
Practice Address - Street 1:909 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1203
Practice Address - Country:US
Practice Address - Phone:563-578-3244
Practice Address - Fax:563-578-3247
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0226738Medicaid
22673Medicare PIN
IA0226738Medicaid