MEDICARE: PATRICIO ROSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	51570	KY
2	2086S0129X	Vascular Surgery Physician	ME111938	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	57913	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1629055868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIO ROSA MD

Provider Business Mailing Address
First Line	:	1665 QUIRKS RUN RD
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-8830
Country	:	US
Telephone Number	:	859-236-4269
Fax Number	:	859-545-4945

Provider Business Practice Location Address
First Line	:	1010 WOODLAND DR
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-3706
Country	:	US
Telephone Number	:	270-706-5171
Fax Number	:	270-706-5738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/08/2026

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