Provider Demographics
NPI:1205950284
Name:IWUNZE, ROSEMARY (MD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:IWUNZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FALL HILL AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3343
Mailing Address - Country:US
Mailing Address - Phone:407-411-1005
Mailing Address - Fax:540-741-3554
Practice Address - Street 1:1101 SAM PERRY BLVD STE 307
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4466
Practice Address - Country:US
Practice Address - Phone:540-374-3277
Practice Address - Fax:540-741-9744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065720207R00000X
VA0101263347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414096600Medicaid
DC124845Medicare PIN
MD211NMedicare PIN