Provider Demographics
NPI:1891745287
Name:ROSADO, MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ROSADO
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:P. O. BOX 8500 - 6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-493-0100
Mailing Address - Fax:215-493-7528
Practice Address - Street 1:680 HEACOCK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6346
Practice Address - Country:US
Practice Address - Phone:215-493-0100
Practice Address - Fax:215-493-7528
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028372E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3942578OtherAETNA HMO
PA0004589930OtherAETNA PPO
PA0017430290005Medicaid
PA0045824000OtherIBC,KEYSTONE
PA111911OtherPERSONAL CHOICE
PA30023765OtherKEYSTONE MERCY
PA111911OtherHIGHMARK BLUE SHIELD
PA9193912OtherCIGNA
PA0017430290003Medicaid
PA0017430290012Medicaid
PA01743029-04OtherAMERICHOICE
PA1838053OtherUNITED HEALTHCARE
PA0017430290004Medicaid
PA35651OtherHEALTH PARTNERS
PA0004589930OtherAETNA PPO
PA01743029-04OtherAMERICHOICE