Healthcare Provider Details

I. General information

NPI: 1124808241
Provider Name (Legal Business Name): ROSE PEDIATRICS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ANNAPOLIS RD STE B7
LANHAM MD
20706-2080
US

IV. Provider business mailing address

PO BOX 266
LANHAM MD
20703-0266
US

V. Phone/Fax

Practice location:
  • Phone: 301-429-5866
  • Fax: 301-429-8818
Mailing address:
  • Phone: 301-429-5866
  • Fax: 301-429-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHINYERE ROSE AMAZU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 301-429-5866