Provider Demographics
NPI:1225030034
Name:GAUHAR, ROSE SAMUELS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:SAMUELS
Last Name:GAUHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSELINE
Other - Middle Name:SAMUELS
Other - Last Name:GAUHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2904 ANDREA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1906
Mailing Address - Country:US
Mailing Address - Phone:410-661-4187
Mailing Address - Fax:410-728-5291
Practice Address - Street 1:1501 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3121
Practice Address - Country:US
Practice Address - Phone:410-383-8300
Practice Address - Fax:410-728-5291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70714Medicare UPIN