Provider Demographics
NPI:1780842674
Name:ROSELL, WILFREDO GO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:GO
Last Name:ROSELL
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 1:33 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1497
Mailing Address - Country:US
Mailing Address - Phone:518-626-5237
Mailing Address - Fax:
Practice Address - Street 1:33 DEPOT ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1497
Practice Address - Country:US
Practice Address - Phone:518-626-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255195-1207R00000X
DEC1-0009740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine