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General NPI Number Information
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NPI Number | 1972951440
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Entity Type | Organization
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Legal Business Name | ROSEDALE PRIMARY CARE PHYSICIAN, P.C.
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 19 FONTANA LN SUITE 108-110
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City | ROSEDALE
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State | MD
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Zip | 21237-3047
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Country | US
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Telephone | 410-218-5523
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Fax |
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Provider Business Mailing Address
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Address Line | 540 MONTCLAIR CT
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City | PARKTON
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State | MD
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Zip | 21120-9801
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Country | US
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Telephone | 410-218-5523
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Fax |
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | DR. XIAOFEI LI
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Credential |
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Telephone | 410-218-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0076990
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License Number State | MD
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