Provider Demographics
NPI:1922007939
Name:ROSCH, JEFFREY M (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:ROSCH
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 1:800 SOUTH LOGAN BOULEVARD, SUITE 3200
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3050
Mailing Address - Country:US
Mailing Address - Phone:814-944-2097
Mailing Address - Fax:814-941-2303
Practice Address - Street 1:800 SOUTH LOGAN BOULEVARD
Practice Address - Street 2:SUITE 3200
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3050
Practice Address - Country:US
Practice Address - Phone:814-944-2097
Practice Address - Fax:814-941-2303
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015039E174400000X
PAMD439200207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006188300004Medicaid
PA1031084300001Medicaid
PA075017Medicare ID - Type Unspecified