Provider Demographics
NPI:1851354401
Name:PADILLA, ROSALIE (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:PADILLA
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 1:4863 SCOTTSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7949
Mailing Address - Country:US
Mailing Address - Phone:270-843-5662
Mailing Address - Fax:270-843-5614
Practice Address - Street 1:4863 SCOTTSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7949
Practice Address - Country:US
Practice Address - Phone:270-843-5662
Practice Address - Fax:270-843-5614
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25071207P00000X, 207R00000X
KY2501207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC71892Medicare UPIN