Provider Demographics
NPI:1528152469
Name:ROSAL, RUFINO V (MD)
Entity type:Individual
Prefix:MR
First Name:RUFINO
Middle Name:V
Last Name:ROSAL
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 1:38 DEAK DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-261-5600
Mailing Address - Fax:302-653-9563
Practice Address - Street 1:38 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-261-5600
Practice Address - Fax:302-653-9563
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI0005332OtherLICENSE
9832OtherSITE ID
DE1000030451Medicaid
CI0005332OtherLICENSE
BR4976289OtherDEA
9832OtherSITE ID