Healthcare Provider Details

I. General information

NPI: 1265643514
Provider Name (Legal Business Name): ROSELINE MORDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 ANNAPOLIS RD STE 100
LANHAM MD
20706-3133
US

IV. Provider business mailing address

14356 ROSETREE CT
SILVER SPRING MD
20906-1941
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6300
  • Fax:
Mailing address:
  • Phone: 240-277-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG12200
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: