MEDICARE: DR. THOMAS KOSTAS ROSVANIS M.D.

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	174400000X	Specialist	MD040731E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251219366	OTHER	PA	FEDERAL TAX ID#

General Provider Information

NPI Number	:	1093710048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KOSTAS ROSVANIS M.D.

Provider Business Mailing Address
First Line	:	2580 HAYMAKER RD
Second Line	:	STE 401
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-3500
Country	:	US
Telephone Number	:	412-372-6330
Fax Number	:	412-372-3319

Provider Business Practice Location Address
First Line	:	2580 HAYMAKER RD
Second Line	:	STE 401
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-3500
Country	:	US
Telephone Number	:	412-372-6330
Fax Number	:	412-372-3319

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/04/2008

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