Provider Demographics
NPI:1659802924
Name:ROSSI, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ROSSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ALYSHEBA WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2381
Mailing Address - Country:US
Mailing Address - Phone:859-278-5007
Mailing Address - Fax:859-278-6867
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-323-6712
Practice Address - Fax:859-257-7231
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP461207Q00000X
KYR4580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty