Healthcare Provider Details

I. General information

NPI: 1821075441
Provider Name (Legal Business Name): OSCAR ONEILL-ROSADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OSCAR ONEILL MD

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR STE 1B
MELBOURNE FL
32901
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-3324
  • Fax: 321-409-1786
Mailing address:
  • Phone: 321-312-3324
  • Fax: 321-409-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME112318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: