Provider Demographics
NPI:1578503751
Name:VIDAL, ROSA A (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-415-1546
Mailing Address - Fax:251-415-1026
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:PICU
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:215-415-1546
Practice Address - Fax:251-415-1026
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL245952080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263997100Medicaid
AL39-00626OtherUNITED HEALTHCARE
MS00125518Medicaid
AL51507738OtherBCBS
AL009981610Medicaid
LA1699098Medicaid
FL263997100Medicaid
FL263997100Medicaid
LA1699098Medicaid