Provider Demographics
NPI:1891801445
Name:HACKETT, ROSEOH MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSEOH
Middle Name:MARIE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4181
Mailing Address - Fax:859-258-4058
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4181
Practice Address - Fax:859-258-4058
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00472053OtherRR MEDICARE PIN
KYP00472053OtherRR MEDICARE PIN
C75404Medicare UPIN