MEDICARE: DR. ROSCHIEL DOBLE TIU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	D0065063	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89406701 - KR10ME	OTHER	MD	BCBS MARYLAND FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
2	1851473722	OTHER	MD	GROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1710998968	OTHER	MD	GROUP NPI - FORT WASHINGTON OBGYN SERVICES
5	B776-0029	OTHER	DC	BCBS NCA FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND

General Provider Information

NPI Number	:	1033200910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSCHIEL DOBLE TIU M.D.

Provider Business Mailing Address
First Line	:	10403 HOSPITAL DR
Second Line	:	SUITE G-04
City	:	CLINTON
State	:	MD
Zip	:	20735-3134
Country	:	US
Telephone Number	:	301-856-3019
Fax Number	:	301-856-9370

Provider Business Practice Location Address
First Line	:	950 SWAN CREEK RD E
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5250
Country	:	US
Telephone Number	:	301-292-0236
Fax Number	:	301-856-9370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/14/2009

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