Provider Demographics
NPI:1952497703
Name:ROSSI, SAMUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 TRACY WAY
Mailing Address - Street 2:STE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1262
Mailing Address - Country:US
Mailing Address - Phone:304-388-1724
Mailing Address - Fax:304-388-1721
Practice Address - Street 1:600 TRACY WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1262
Practice Address - Country:US
Practice Address - Phone:304-388-4965
Practice Address - Fax:304-388-4968
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV21558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I27460Medicare UPIN
WV3810002636Medicaid
WVRO6033281Medicare ID - Type Unspecified
6033282Medicare PIN