Individual
GREGORY JAMES ROSCOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
871 BEAVER DR, DU BOIS, PA 15801-2511
(814) 375-0455
(814) 375-2721
Mailing address
871 BEAVER DRIVE, PO BOX 308, DUBOIS, PA 15801-0308
(814) 375-0455
(814) 375-2721
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD038440L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008776540004
—
PA
01
—
040000667
RAILROAD MEDICARE, PIN
PA
01
—
161530
HIGHMARK BLUE SHIELD
PA
Enumeration date
10/17/2006
Last updated
07/23/2008
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