Healthcare Provider Details

I. General information

NPI: 1790707008
Provider Name (Legal Business Name): CHRISTOPHER ALLEN ROUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE WALTER REED MILITARY MEDICAL CENTER, DEPT OF PEDIATRICS
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE WALTER REED MILITARY MEDICAL CENTER, DEPT OF PEDIATRICS
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-6428
  • Fax:
Mailing address:
  • Phone: 301-319-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.086878
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0080871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: