Provider Demographics
NPI:1376809491
Name:DR. ROSI PEDIATRICS, LLC
Entity type:Organization
Organization Name:DR. ROSI PEDIATRICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:P
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:352-284-1031
Mailing Address - Street 1:PO BOX 357446
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7446
Mailing Address - Country:US
Mailing Address - Phone:352-375-0001
Mailing Address - Fax:352-375-7897
Practice Address - Street 1:2131 NW 40TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3599
Practice Address - Country:US
Practice Address - Phone:352-375-0001
Practice Address - Fax:352-375-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME046909208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty