Provider Demographics
NPI:1962625533
Name:CHAPPELL ROSSO DERMATOLOGY PA
Entity type:Organization
Organization Name:CHAPPELL ROSSO DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITCHIE
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-650-6954
Mailing Address - Street 1:4040 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2233
Mailing Address - Country:US
Mailing Address - Phone:432-333-6603
Mailing Address - Fax:432-333-8014
Practice Address - Street 1:4040 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2233
Practice Address - Country:US
Practice Address - Phone:432-333-6603
Practice Address - Fax:432-333-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2507174400000X
207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B40SMedicare PIN
TXB21780Medicare UPIN
TX081698501Medicaid