Provider Demographics
NPI:1386961308
Name:ROSSITTER, CHAD WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WESLEY
Last Name:ROSSITTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:W
Other - Last Name:ROSSITTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1620 COMMERCE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-2066
Mailing Address - Country:US
Mailing Address - Phone:337-594-0675
Mailing Address - Fax:781-464-2551
Practice Address - Street 1:1620 COMMERCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-2066
Practice Address - Country:US
Practice Address - Phone:337-594-0675
Practice Address - Fax:781-464-2551
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206575207RN0300X
LAMD.206575207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107470Medicaid