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General NPI Number Information
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NPI Number | 1073704151
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Entity Type | Individual
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Provider Name | GAIL SUE-ANN ROSE-GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | PM PEDIATRICS OF ANNAPOLIS FESTIVAL AT RIVA SHOPPING CENTER, 2301-A FOREST DRIVE
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-266-6767
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Fax | 410-266-6761
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Provider Business Mailing Address
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Address Line | 8585 DARK HAWK CIR
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City | COLUMBIA
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State | MD
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Zip | 21045-5614
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Country | US
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Telephone | 276-886-0545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 268459
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0084290
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License Number State | MD
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