Healthcare Provider Details

I. General information

NPI: 1154686392
Provider Name (Legal Business Name): DANIEL CHRISTOPHER ROSKO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-1420
  • Fax:
Mailing address:
  • Phone: 502-568-7364
  • Fax: 502-568-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: