Provider Demographics
NPI:1932668829
Name:ROSARIO, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BLUERIDGE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4517
Mailing Address - Country:US
Mailing Address - Phone:301-933-6440
Mailing Address - Fax:
Practice Address - Street 1:2401 BLUERIDGE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4517
Practice Address - Country:US
Practice Address - Phone:301-933-6440
Practice Address - Fax:301-933-5923
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD93494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program