Provider Demographics
NPI:1497154470
Name:ST. AGNES HOSPITAL
Entity Type:Organization
Organization Name:ST. AGNES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEWELL
Authorized Official - Middle Name:VALENTINO
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-368-2718
Mailing Address - Street 1:900 CATON AVE
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:410-368-2718
Mailing Address - Fax:
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP30339390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty