Provider Demographics
NPI:1952389793
Name:DA ROSSO, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DA ROSSO
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 1:10750 COLUMBIA PIKE STE 230
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4454
Mailing Address - Country:US
Mailing Address - Phone:301-585-9600
Mailing Address - Fax:301-585-5888
Practice Address - Street 1:10750 COLUMBIA PIKE STE 230
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4454
Practice Address - Country:US
Practice Address - Phone:301-585-9600
Practice Address - Fax:301-585-5888
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174803208000000X
MDD0082579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01761004Medicaid
OR542791Medicare PIN
G51244Medicare UPIN