Healthcare Provider Details

I. General information

NPI: 1275996886
Provider Name (Legal Business Name): ALEXANDRIA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRIA M MORALES

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MARBLEDALE CT
REISTERSTOWN MD
21136-3210
US

IV. Provider business mailing address

6 MARBLEDALE CT
REISTERSTOWN MD
21136-3210
US

V. Phone/Fax

Practice location:
  • Phone: 301-814-1432
  • Fax:
Mailing address:
  • Phone: 301-814-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR194817
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-50866
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: