Provider Demographics
NPI:1073704151
Name:ROSE-GREEN, GAIL SUE-ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:SUE-ANN
Last Name:ROSE-GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 DARK HAWK CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5614
Mailing Address - Country:US
Mailing Address - Phone:276-886-0545
Mailing Address - Fax:
Practice Address - Street 1:PM PEDIATRICS OF ANNAPOLIS
Practice Address - Street 2:FESTIVAL AT RIVA SHOPPING CENTER, 2301-A FOREST DRIVE
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-6767
Practice Address - Fax:410-266-6761
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268459208000000X
MDD0084290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03323842Medicaid