Healthcare Provider Details

I. General information

NPI: 1093647851
Provider Name (Legal Business Name): STEPHEN ROSE
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: STEVE ROSE

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BOILER HOUSE RD BLDG 80
PERRY POINT MD
21902-1103
US

IV. Provider business mailing address

617 WINANS WAY
BALTIMORE MD
21229-1431
US

V. Phone/Fax

Practice location:
  • Phone: 443-303-0093
  • Fax:
Mailing address:
  • Phone: 443-303-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: