Provider Demographics
NPI:1558336537
Name:ROSARIO, DOMINGO J (MD)
Entity Type:Individual
Prefix:
First Name:DOMINGO
Middle Name:J
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 1:1983 OAKWELL FARMS PKWY
Mailing Address - Street 2:# 1804
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1724
Mailing Address - Country:US
Mailing Address - Phone:210-831-2275
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DRIVE, MCHE-QD (CREDS)
Practice Address - Street 2:FORT SAM HOUSTON
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-5550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060799A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology