MEDICARE: MR. RYAN MATTHEW ROSEBROUGH MPAS, PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1487027058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN MATTHEW ROSEBROUGH MPAS, PA-C

Provider Business Mailing Address
First Line	:	2203 ALLISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-5024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 ALLISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-5024
Country	:	US
Telephone Number	:	317-292-2153
Fax Number	:

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

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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