Provider Demographics
NPI:1487396768
Name:ROSA, ROBERTO LUIS (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:LUIS
Last Name:ROSA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-0756
Mailing Address - Country:US
Mailing Address - Phone:203-903-6519
Mailing Address - Fax:
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4124
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant