Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | RT004978 | PA |
Y | 213ES0000X | Sports Medicine | RT004978 | PA |
NPI | 1336645860 |
---|---|
Provider Name | Rocky Marsero |
First Address | Springfield, PA 19064-2045 |
Second Address | Springfield, PA 19064-2045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |