Healthcare Provider Details

I. General information

NPI: 1346943289
Provider Name (Legal Business Name): ANNA WATKIN ROOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA LEE WATKIN

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

8910 OLD FREDERICK RD
ELLICOTT CITY MD
21043-1926
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0105909
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: