Healthcare Provider Details

I. General information

NPI: 1497853485
Provider Name (Legal Business Name): FABIAN H ROSSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND STREET
ORLANDO FL
32803
US

IV. Provider business mailing address

2336 BUCKINGHAM RUN CT
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-1599
  • Fax: 407-599-1389
Mailing address:
  • Phone: 407-275-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME75752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: