Healthcare Provider Details

I. General information

NPI: 1205100989
Provider Name (Legal Business Name): ROSALIE L. BAIR, M.D., P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5612 SHIELDS DR
BETHESDA MD
20817-3532
US

IV. Provider business mailing address

5612 SHIELDS DR
BETHESDA MD
20817-3532
US

V. Phone/Fax

Practice location:
  • Phone: 301-571-4334
  • Fax: 301-571-4315
Mailing address:
  • Phone: 301-571-4334
  • Fax: 301-571-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberD0047816
License Number StateMD

VIII. Authorized Official

Name: DR. ROSALIE LYNN BAIR
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 301-571-4334