Provider Demographics
NPI:1467633255
Name:FERNANDEZ, ROSARIO P (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:P
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:SUITE C102
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-868-8200
Mailing Address - Fax:301-868-6776
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE C102
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-868-8200
Practice Address - Fax:301-868-6776
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0006-0002OtherCAREFIRST BLUESHIELD
DC001213F00Medicare PIN
DC0006-0002OtherCAREFIRST BLUESHIELD