Healthcare Provider Details

I. General information

NPI: 1346401189
Provider Name (Legal Business Name): ROSE - MARIE ST JEAN SYLLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSE -MARIE SYLLA MD

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 ELIOTS OAK RD
COLUMBIA MD
21044-1826
US

IV. Provider business mailing address

5209 ELIOTS OAK RD
COLUMBIA MD
21044-1826
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-0529
  • Fax: 301-596-4649
Mailing address:
  • Phone: 240-460-0529
  • Fax: 301-596-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD28934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: