Provider Demographics
NPI:1972501146
Name:PAU, ROSANNA (MD)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:PAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3324
Mailing Address - Country:US
Mailing Address - Phone:703-687-4158
Mailing Address - Fax:703-687-4159
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7146
Practice Address - Fax:717-267-7728
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254402207P00000X
MDD0063154207P00000X
PAMD426441207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000532Medicaid
PA101100854Medicaid
VA010442320Medicaid
PA4140351Medicare ID - Type Unspecified
I14002Medicare UPIN
WV3810000532Medicaid