Provider Demographics
NPI:1558490029
Name:ROSA H ROBISON MD DDS PA
Entity Type:Organization
Organization Name:ROSA H ROBISON MD DDS PA
Other - Org Name:ORAL HEAD & NECK PATHOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:407-286-2330
Mailing Address - Street 1:5036 DR PHILLIPS BLVD # 315
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3310
Mailing Address - Country:US
Mailing Address - Phone:407-286-2330
Mailing Address - Fax:407-523-0496
Practice Address - Street 1:2131 WESTOVER RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786
Practice Address - Country:US
Practice Address - Phone:407-286-2330
Practice Address - Fax:407-523-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH825Medicare PIN