Provider Demographics
NPI:1720170137
Name:CANOSO, ROSA T (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:T
Last Name:CANOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2947
Mailing Address - Country:US
Mailing Address - Phone:619-699-6020
Mailing Address - Fax:
Practice Address - Street 1:79 HOWLAND RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2947
Practice Address - Country:US
Practice Address - Phone:619-699-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34553207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology