Provider Demographics
NPI:1184804551
Name:DR ROSELYN E EPPS PA
Entity type:Organization
Organization Name:DR ROSELYN E EPPS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-495-9646
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-495-9646
Mailing Address - Fax:301-495-9343
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-495-9646
Practice Address - Fax:301-495-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
686874Medicare PIN