Provider Demographics
NPI:1861491425
Name:ROSEMORE, JUSTIN GARTH (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GARTH
Last Name:ROSEMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6209 GREEN MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3300
Mailing Address - Country:US
Mailing Address - Phone:410-585-0027
Mailing Address - Fax:410-585-0027
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 206
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6208
Practice Address - Country:US
Practice Address - Phone:443-801-7151
Practice Address - Fax:410-585-1619
Is Sole Proprietor?:No
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH0055317207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH93140Medicare UPIN