Provider Demographics
NPI:1811009640
Name:ROSIECKI, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ROSIECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:1360 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-961-2504
Practice Address - Fax:570-347-6585
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011303E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
818445OtherFIRST PRIORITY HEALTH
00178790OtherRAILROAD MEDICARE
PA007042290Medicaid
054666OtherHIGH MARK BLUE SHIELD
11954OtherGEISINGER HEALTH PLAN
506554OtherAETNA
818445OtherFIRST PRIORITY HEALTH
506554OtherAETNA