Provider Demographics
NPI:1811922693
Name:COSSIO, ROBERTO M (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:M
Last Name:COSSIO
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 1:322 STEPHENSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5998
Mailing Address - Country:US
Mailing Address - Phone:912-354-3130
Mailing Address - Fax:912-354-5860
Practice Address - Street 1:322 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5929
Practice Address - Country:US
Practice Address - Phone:912-354-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000532727AMedicaid