Provider Demographics
NPI:1396035069
Name:DODD, ROSEMARY W (CRNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:W
Last Name:DODD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:MUNYIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:25 CROSSROADS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5421
Practice Address - Country:US
Practice Address - Phone:410-602-7792
Practice Address - Fax:410-602-9889
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172973363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD041979600Medicaid
MD217756Y56OtherMEDICARE PTAN