Provider Demographics
NPI:1891772042
Name:ROSSI, MAURO ANGELO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAURO
Middle Name:ANGELO
Last Name:ROSSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:BUILDING 300 SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-546-7417
Mailing Address - Fax:706-612-1310
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BUILDING 300 SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-546-7417
Practice Address - Fax:706-612-1310
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000767213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00679533AMedicaid
U32554Medicare UPIN
GA00679533AMedicaid
GA1891772042Medicare NSC