Provider Demographics
NPI:1720283807
Name:ROSSI, DAVID JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:ROSSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13620 CRAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2335
Mailing Address - Country:US
Mailing Address - Phone:240-313-9890
Mailing Address - Fax:
Practice Address - Street 1:13620 CRAYTON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2335
Practice Address - Country:US
Practice Address - Phone:240-313-9890
Practice Address - Fax:240-313-9891
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202082207Q00000X
MDH72413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3810009594OtherWV MEDICAID
VA1720283807OtherSOUTHERN HEALTH
VA1720283807Medicaid
VA1000870001OtherDME PROVIDER NUMBER
VA1607812OtherCIGNA
VAP00458992OtherRAILROAD MEDICARE
VA309394OtherANTHEM
VA1720283807Medicaid