Provider Demographics
NPI:1881609527
Name:ROSARIO, PATRICK G (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
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:PO BOX 2503
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1703
Mailing Address - Country:US
Mailing Address - Phone:412-269-9898
Mailing Address - Fax:412-269-9899
Practice Address - Street 1:124 OLDE MANOR LN
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-9793
Practice Address - Country:US
Practice Address - Phone:412-269-9898
Practice Address - Fax:412-269-9899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350753892086S0129X, 208D00000X, 208G00000X
PAMD063158L2086S0129X, 208D00000X, 208G00000X
WV194952086S0129X, 208D00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016955850002Medicaid
PAPA63158BOtherHEALTH PLAN UPPER OH VALL
OH000000216217OtherANTHEM
PA102968OtherUPMC
PA81962OtherTHREE RIVERS
OHA75389OtherHEALTH PLAN UPPER OH VALL
WVA75389AOtherHEALTH PLAN UPPER OH VALL
WV0022015000Medicaid
OH2062477Medicaid
WV0022015000Medicaid
PAPA63158BOtherHEALTH PLAN UPPER OH VALL
PA010517Medicare ID - Type Unspecified
OH000000216217OtherANTHEM
OHA75389OtherHEALTH PLAN UPPER OH VALL