Provider Demographics
NPI:1235260423
Name:ROANE, JUDITH CARSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:CARSON
Last Name:ROANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 ANCHORAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4303
Mailing Address - Country:US
Mailing Address - Phone:410-268-5686
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY STE 250
Practice Address - Street 2:WOMEN OB GYN
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3098
Practice Address - Country:US
Practice Address - Phone:410-224-2228
Practice Address - Fax:410-266-7778
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO51859363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health