Provider Demographics
NPI:1811969322
Name:ROSANDICH, RONALD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:ROSANDICH
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 1:8010 MOUNTAIN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7840
Mailing Address - Country:US
Mailing Address - Phone:505-268-2481
Mailing Address - Fax:505-268-0889
Practice Address - Street 1:8010 MOUNTAIN RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7840
Practice Address - Country:US
Practice Address - Phone:505-268-2481
Practice Address - Fax:505-268-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70192207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2355OtherBLUE CROSS
24998OtherPRESBYTERIAN
NM23556Medicaid
NMC98062Medicare UPIN
NM23556Medicaid