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General NPI Number Information
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NPI Number | 1679055420
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Entity Type | Individual
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Provider Name | MARIYA ROGERS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 1576 MERRITT BLVD STE 18
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City | DUNDALK
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State | MD
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Zip | 21222
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Country | US
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Telephone | 410-571-2946
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Fax |
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Provider Business Mailing Address
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Address Line | 1576 MERRITT BLVD # 18
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City | DUNDALK
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State | MD
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Zip | 21222-2132
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Country | US
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Telephone | 443-693-7246
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R196400
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License Number State | MD
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