Provider Demographics
NPI:1316622996
Name:ROSVALL, BRANDON RICHARD (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RICHARD
Last Name:ROSVALL
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 1:203 LOTHROP STREET
Mailing Address - Street 2:5TH FLOOR, SUITE 521
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-647-8186
Mailing Address - Fax:
Practice Address - Street 1:203 LOTHROP STREET
Practice Address - Street 2:SUITE 521
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481110207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology