=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114458320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVER ROZAL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2017
-----------------------------------------------------
Last Update Date | 03/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E UNIVERSITY PKWY
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-261-8496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 RODAN CT
-----------------------------------------------------
City | MILLERSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21108-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-928-8494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 246ZC0007X
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------