Provider Demographics
NPI:1669659918
Name:COUSINS, ROSEANNE (MD)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:COUSINS
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 1:363 CHAMBORLEY DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6151
Mailing Address - Country:US
Mailing Address - Phone:301-213-7755
Mailing Address - Fax:
Practice Address - Street 1:363 CHAMBORLEY DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6151
Practice Address - Country:US
Practice Address - Phone:301-213-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN9165207R00000X
MDD0082494207R00000X
NY248801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine