Provider Demographics
NPI:1316779192
Name:ROSEBORO, XAVIER DISHON
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:DISHON
Last Name:ROSEBORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-2019
Mailing Address - Country:US
Mailing Address - Phone:330-234-5251
Mailing Address - Fax:
Practice Address - Street 1:80 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-2019
Practice Address - Country:US
Practice Address - Phone:330-234-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist