Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD436862 | PA |
N | 208600000X | Surgeon | MD436862 | PA |
Y | 2086S0129X | Vascular Surgeon | MD436862 | PA |
NPI | 1164626743 |
---|---|
Provider Name | Carlos Alberto Rosales |
First Address | Monroeville, PA 15146-3554 |
Second Address | Monroeville, PA 15146-3554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102322098 | (05) | PA |
11975315 | CAQH (01) |