Provider Demographics
NPI:1578667127
Name:ROSSMAN, STANLEY HERSCHEL (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:HERSCHEL
Last Name:ROSSMAN
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 1:6850 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4451
Mailing Address - Country:US
Mailing Address - Phone:818-994-0101
Mailing Address - Fax:818-902-5566
Practice Address - Street 1:6850 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4451
Practice Address - Country:US
Practice Address - Phone:818-994-0101
Practice Address - Fax:818-994-2126
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25627207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31206ZOtherBLUE SHIELD
W11063AOtherMEDICARE ID
CA1669576211OtherNPI
CAGR0044500Medicaid
CAZZZ47615ZOtherBLUE SHIELD
CA1851495501OtherNPI
CAGR0044501Medicaid
CA1851495501OtherNPI
A90954Medicare UPIN