Provider Demographics
NPI:1912570805
Name:ROSAVAN TEMPLE HILLS
Entity Type:Organization
Organization Name:ROSAVAN TEMPLE HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-863-2822
Mailing Address - Street 1:4703 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1816
Mailing Address - Country:US
Mailing Address - Phone:240-863-2822
Mailing Address - Fax:
Practice Address - Street 1:4037 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1643
Practice Address - Country:US
Practice Address - Phone:240-863-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty