Doctor Name: | JUSTIN THEODORE ROSCOE |
NPI Number: | 1487622353 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D0036008 |
Business Practice Address: | 600 Ridgely Ave Suite 123 Annapolis, MD - 214011001 |
Business Phone Number: | 4102243614 |
Business Fax Number: | 4102245836 |
Mailing Address: | 600 Ridgely Ave, Suite 120 ANNAPOLIS |
State: | MD |
Postal Code: | 214011001 |
Phone Number: | 4102247795 |
Fax Number: | 4102245826 |
NPI Enumeration Date: | 03/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | D0036008 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |