Healthcare Provider Details

I. General information

NPI: 1023646411
Provider Name (Legal Business Name): DEBORAH KATHLEEN ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ALPHA COMMONS DR
BALTIMORE MD
21224-1750
US

IV. Provider business mailing address

801 E DOUGLAS AVE OFC 233
WICHITA KS
67202-3548
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-6337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-50344
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: