Provider Demographics
NPI:1952636326
Name:MADJAROFF, ROSSIE (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:ROSSIE
Middle Name:
Last Name:MADJAROFF
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:ROSSITZA
Other - Middle Name:
Other - Last Name:MADJAROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-1064
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-3167
Practice Address - Fax:410-328-1323
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003170363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q55133Medicare UPIN