Provider Demographics
NPI:1023127909
Name:ROSARIO, ANGEL M (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
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 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-930-8816
Mailing Address - Fax:813-932-1856
Practice Address - Street 1:6919 N DALE MABRY HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-930-8816
Practice Address - Fax:813-932-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53996207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058398700Medicaid
FL11962AMedicare ID - Type Unspecified
FL058398700Medicaid
FLE83285Medicare UPIN