Provider Demographics
NPI:1194919100
Name:ROSSO, MARIA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:ROSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 BUFORD HWY NE
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1081
Mailing Address - Country:US
Mailing Address - Phone:404-785-8160
Mailing Address - Fax:
Practice Address - Street 1:4166 BUFORD HWY NE
Practice Address - Street 2:SUITE 1102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1081
Practice Address - Country:US
Practice Address - Phone:404-785-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200995208000000X
GA060864208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238074Medicaid