MEDICARE: ROSE BOHAN AMBROSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D 0061342	MD

General Provider Information

NPI Number	:	1558311555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE BOHAN AMBROSE M.D.

Provider Business Mailing Address
First Line	:	11930 NEW COUNTRY LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4405
Country	:	US
Telephone Number	:	410-772-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	10632 LITTLE PATUXENT PKWY
Second Line	:	SUITE 330
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3273
Country	:	US
Telephone Number	:	443-226-2627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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