Provider Demographics
NPI:1346401189
Name:ST JEAN SYLLA, ROSE - MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE - MARIE
Middle Name:
Last Name:ST JEAN SYLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSE -MARIE
Other - Middle Name:
Other - Last Name:SYLLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5209 ELIOTS OAK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1826
Mailing Address - Country:US
Mailing Address - Phone:240-460-0529
Mailing Address - Fax:301-596-4649
Practice Address - Street 1:5209 ELIOTS OAK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1826
Practice Address - Country:US
Practice Address - Phone:240-460-0529
Practice Address - Fax:301-596-4649
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD289342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine