Provider Demographics
NPI:1861483737
Name:ROSARIO-MEDINA, WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:ROSARIO-MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:211 PARK STREET
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-236-7750
Practice Address - Fax:508-223-3026
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA577742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3021513Medicaid
MAP00478176OtherRR MEDICARE
MAR01133OtherBCBS MA
MA6347436002OtherCIGNA NH
MA300134594OtherRAILROAD MEDICARE
MA344540OtherHARVARD PILGRIM
MA000000028367OtherHEALTH NET
MA04-3140277OtherTRICARE
MA410355OtherBLUE CHIP RI
MA04-3140277OtherHCVM FIRST HEALTH
MA16-00012OtherUNITED HEALTHCARE
MA4700OtherBCBS RI
MA775467OtherTUFTS HEALTH PLAN
MA622402OtherCIGNA MA
MAB99170Medicare UPIN
MA04-3140277OtherHCVM FIRST HEALTH
MAR01133OtherBCBS MA