Provider Demographics
NPI:1942224092
Name:ROSELLINI, GREGORY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:ROSELLINI
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 1:9041 BRIDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3132
Mailing Address - Country:US
Mailing Address - Phone:916-714-3280
Mailing Address - Fax:916-714-3280
Practice Address - Street 1:9041 BRIDGEWATER CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3132
Practice Address - Country:US
Practice Address - Phone:916-714-3280
Practice Address - Fax:916-714-3280
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061075207P00000X
CAA61075207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61075OtherCA MEDICAL LICESE
CAG75315Medicare UPIN
CACA176325Medicare PIN