Provider Demographics
NPI:1205590262
Name:ROSA, PETER (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W GUDE DR STE 375
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4300
Mailing Address - Country:US
Mailing Address - Phone:301-545-0800
Mailing Address - Fax:301-545-0885
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 304
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5285
Practice Address - Country:US
Practice Address - Phone:410-878-2530
Practice Address - Fax:667-223-1982
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor