Provider Demographics
NPI:1629230446
Name:ROSARIO, CARMEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MARIE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E ONTARIO ST
Mailing Address - Street 2:APT 1505
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3051
Mailing Address - Country:US
Mailing Address - Phone:614-203-5425
Mailing Address - Fax:
Practice Address - Street 1:1575 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4901
Practice Address - Country:US
Practice Address - Phone:817-702-3431
Practice Address - Fax:817-702-3601
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053239207R00000X
TXS8906207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine