MEDICARE: DR. RUFUS ROSSER JR. 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	207V00000X	Obstetrics & Gynecology Physician	D0021152	MD

General Provider Information

NPI Number	:	1598859019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUFUS ROSSER JR. M.D.

Provider Business Mailing Address
First Line	:	9811 MALLARD DR
Second Line	:	SUITE 115
City	:	LAUREL
State	:	MD
Zip	:	20708-3180
Country	:	US
Telephone Number	:	301-498-2103
Fax Number	:	301-498-2106

Provider Business Practice Location Address
First Line	:	9811 MALLARD DR
Second Line	:	SUITE 115
City	:	LAUREL
State	:	MD
Zip	:	20708-3180
Country	:	US
Telephone Number	:	301-498-2103
Fax Number	:	301-498-2106

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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