Healthcare Provider Details

I. General information

NPI: 1316609548
Provider Name (Legal Business Name): ISABEL BURICK ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR STE G020
COLUMBIA MD
21044-3257
US

IV. Provider business mailing address

5154 PERRY RD
MOUNT AIRY MD
21771-8823
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-2212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: