Provider Demographics
NPI:1306856737
Name:CHRISTODOULOS, ROZALINDE B (NP)
Entity Type:Individual
Prefix:
First Name:ROZALINDE
Middle Name:B
Last Name:CHRISTODOULOS
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 1:3016 E PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2254
Mailing Address - Country:US
Mailing Address - Phone:443-226-1676
Mailing Address - Fax:443-449-5684
Practice Address - Street 1:3016 E PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2254
Practice Address - Country:US
Practice Address - Phone:443-226-1676
Practice Address - Fax:443-449-5684
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142649363LA2100X
MDR185270363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000980449AMedicaid
GA50BBGMZMedicare ID - Type Unspecified
GA000980449AMedicaid