Provider Demographics
NPI:1407007867
Name:ROSEDALE OCCUPATIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:ROSEDALE OCCUPATIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:443-524-2737
Mailing Address - Street 1:8652 PULASKI HWY
Mailing Address - Street 2:C
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3008
Mailing Address - Country:US
Mailing Address - Phone:410-780-8111
Mailing Address - Fax:410-780-8116
Practice Address - Street 1:8652 PULASKI HWY
Practice Address - Street 2:C
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3008
Practice Address - Country:US
Practice Address - Phone:410-780-8111
Practice Address - Fax:410-780-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty