Basic Information
| Provider Information | |||||||||
| NPI: | 1164626743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSALES | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | ALBERTO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2566 HAYMAKER RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128587088 | ||||||||
| FaxNumber: | 4128587016 | ||||||||
| Practice Location | |||||||||
| Address1: | 2566 HAYMAKER RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128587088 | ||||||||
| FaxNumber: | 4128587016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD436862 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD436862 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 11975315 | 01 | CAQH | OTHER | 102322098 | 05 | PA | MEDICAID |