Provider Demographics
NPI:1679547293
Name:MESMER, ROSELLE (MD)
Entity type:Individual
Prefix:
First Name:ROSELLE
Middle Name:
Last Name:MESMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:610-876-2400
Mailing Address - Fax:610-876-4308
Practice Address - Street 1:1 MEDICAL CENTER BLVD - BLDG 1 STE 400
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-876-2400
Practice Address - Fax:610-876-4308
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059184L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001787865 0007Medicaid
PA001787865 0007Medicaid