Provider Demographics
NPI:1881657047
Name:DORSETT, ROSWELL B III (DO)
Entity Type:Individual
Prefix:
First Name:ROSWELL
Middle Name:B
Last Name:DORSETT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WHITE POND DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1127
Mailing Address - Country:US
Mailing Address - Phone:330-572-1011
Mailing Address - Fax:330-572-1018
Practice Address - Street 1:701 WHITE POND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1127
Practice Address - Country:US
Practice Address - Phone:330-572-1011
Practice Address - Fax:330-572-1018
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006138D2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205049Medicaid
OH0205049Medicaid
OH729006OtherBUCKEYE COMMUNITY HEALTH
OH000000338620OtherANTHEM BLUECROSS/BLUESHEI
OH341097565RDOtherSUMMACARE
OH0881345Medicare PIN
OHP00207321OtherRAILROAD MEDICARE