Provider Demographics
NPI:1689612509
Name:MATEO, ROSA I (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:I
Last Name:MATEO
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 1:7651 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8141
Mailing Address - Country:US
Mailing Address - Phone:410-310-6245
Mailing Address - Fax:410-822-9683
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2913
Practice Address - Country:US
Practice Address - Phone:443-477-0949
Practice Address - Fax:410-822-9683
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064147207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00353286OtherPALMETTO GBA/RAILROAD MEDICARE
MD409993100Medicaid
MD88675501OtherCAREFIRST BS
MDE6360012OtherFEDERAL BS
MD208476OtherPRIORITY PARTNERS
MD468LO023Medicare PIN
MD88675501OtherCAREFIRST BS