Healthcare Provider Details

I. General information

NPI: 1104484625
Provider Name (Legal Business Name): ALICIA ISABELLE ROLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 744785
ATLANTA GA
30374-4785
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5000
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351045097
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD210002077
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: