Provider Demographics
NPI:1942311824
Name:ROSEFF, MARTIN H (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:H
Last Name:ROSEFF
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3170
Mailing Address - Fax:812-235-3330
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3170
Practice Address - Fax:812-235-3330
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028433A207Y00000X
IL36096884207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0182810OtherUS DEPT OF LABOR
INP00844259OtherRAILROAD MEDICARE
791041139OtherRAILROAD MCARE PALAMETTO
000000089592OtherANTHEM
IN100250480Medicaid
IN265130HMedicare PIN
0182810OtherUS DEPT OF LABOR
C25902Medicare UPIN
IN859920XMedicare PIN
IN607850IMedicare PIN
IN192770EEEMedicare PIN
INP00844259OtherRAILROAD MEDICARE
IN859910CCMedicare PIN