Basic Information
| Provider Information | |||||||||
| NPI: | 1861483737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSARIO-MEDINA | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 PARK STREET | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027033143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082367750 | ||||||||
| FaxNumber: | 5082233026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 57774 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3021513 | 05 | MA | MEDICAID | P00478176 | 01 | MA | RR MEDICARE | OTHER | R01133 | 01 | MA | BCBS MA | OTHER | 6347436002 | 01 | MA | CIGNA NH | OTHER | 300134594 | 01 | MA | RAILROAD MEDICARE | OTHER | 344540 | 01 | MA | HARVARD PILGRIM | OTHER | 000000028367 | 01 | MA | HEALTH NET | OTHER | 04-3140277 | 01 | MA | TRICARE | OTHER | 410355 | 01 | MA | BLUE CHIP RI | OTHER | 04-3140277 | 01 | MA | HCVM FIRST HEALTH | OTHER | 16-00012 | 01 | MA | UNITED HEALTHCARE | OTHER | 4700 | 01 | MA | BCBS RI | OTHER | 775467 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 622402 | 01 | MA | CIGNA MA | OTHER |