Provider Demographics
NPI:1154357762
Name:ROSATO, RALPH M (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:M
Last Name:ROSATO
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 1:3790 7TH TER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6552
Mailing Address - Country:US
Mailing Address - Phone:772-562-5859
Mailing Address - Fax:772-564-9214
Practice Address - Street 1:3790 7TH TER
Practice Address - Street 2:SUITE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6552
Practice Address - Country:US
Practice Address - Phone:772-562-5859
Practice Address - Fax:772-564-9214
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370301100Medicaid
FLE39060Medicare UPIN
FL370301100Medicaid