=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457798100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. HOLLY ROSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2013
-----------------------------------------------------
Last Update Date | 10/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9920 FRANKLIN SQUARE DR SUITE 150
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-870-0251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 DELRAY DR
-----------------------------------------------------
City | FOREST HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21050-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 01292
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------