Provider Demographics
NPI:1376184531
Name:ROSCIOLI, ADAM JOSEPH
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:ROSCIOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 BRAVERTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2667
Mailing Address - Country:US
Mailing Address - Phone:410-760-2162
Mailing Address - Fax:410-760-2975
Practice Address - Street 1:308 HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6113
Practice Address - Country:US
Practice Address - Phone:410-760-2162
Practice Address - Fax:410-760-2975
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist