Healthcare Provider Details

I. General information

NPI: 1053449140
Provider Name (Legal Business Name): ROSELLA DOREEN SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEST RD #102
BALTIMORE MD
21204-2316
US

IV. Provider business mailing address

110 WEST RD #102
BALTIMORE MD
21204-2316
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-6400
  • Fax: 410-296-6405
Mailing address:
  • Phone: 410-296-6400
  • Fax: 410-296-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License NumberD31373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: