Provider Demographics
NPI:1730501503
Name:ROTUNDA, ROSEANNE
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:ROTUNDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15235 SHADY GROVE RD
Mailing Address - Street 2:#102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3234
Mailing Address - Country:US
Mailing Address - Phone:301-330-9430
Mailing Address - Fax:301-330-6515
Practice Address - Street 1:15235 SHADY GROVE RD
Practice Address - Street 2:#102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3234
Practice Address - Country:US
Practice Address - Phone:301-330-9430
Practice Address - Fax:301-330-6515
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH77018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine