Provider Demographics
NPI:1649570060
Name:ROSOWSKI, JEFFREY M (PA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:ROSOWSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3320 EXECUTIVE DR
Mailing Address - Street 2:STE 222
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7445
Mailing Address - Country:US
Mailing Address - Phone:919-596-3400
Mailing Address - Fax:919-596-3499
Practice Address - Street 1:3320 EXECUTIVE DR STE 222
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-877-1100
Practice Address - Fax:919-877-8118
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102924363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S92006Medicare UPIN
2752661FMedicare PIN