Provider Demographics
NPI:1558497438
Name:ROSA, ANTHONY T (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:T
Last Name:ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33845-2159
Mailing Address - Country:US
Mailing Address - Phone:863-421-9393
Mailing Address - Fax:863-421-9622
Practice Address - Street 1:2235 NORTH BLVD WEST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-421-8674
Practice Address - Fax:863-421-9622
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00655962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87797Medicare UPIN
FL25559YMedicare ID - Type Unspecified