Basic Information
| Provider Information | |||||||||
| NPI: | 1881657047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORSETT | ||||||||
| FirstName: | ROSWELL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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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 | 2084N0400X | 34006138D | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00207321 | 01 | OH | RAILROAD MEDICARE | OTHER | 0205049 | 05 | OH | MEDICAID | 729006 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER | 000000338620 | 01 | OH | ANTHEM BLUECROSS/BLUESHEI | OTHER | 341097565RD | 01 | OH | SUMMACARE | OTHER |