Provider Demographics
NPI:1689675761
Name:ROSSEN, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:ROSSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:31 CAMPUS PLAZA RD STE B
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9534
Mailing Address - Country:US
Mailing Address - Phone:413-406-3033
Mailing Address - Fax:413-387-0560
Practice Address - Street 1:31 CAMPUS PLAZA RD STE B
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9534
Practice Address - Country:US
Practice Address - Phone:413-406-3033
Practice Address - Fax:413-387-0560
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2199842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3176541Medicaid
MAA23367Medicare ID - Type Unspecified
MAI09661Medicare UPIN