Provider Demographics
NPI:1437189479
Name:ROSADOMARTINEZ, MAGGIE (MD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:ROSADOMARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7105
Mailing Address - Fax:407-282-8019
Practice Address - Street 1:2285 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2703
Practice Address - Country:US
Practice Address - Phone:407-281-6054
Practice Address - Fax:407-282-8019
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43826207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278340100Medicaid
FL278340100Medicaid
FLC79539Medicare UPIN