Provider Demographics
NPI:1255775284
Name:ROSCH, KERI SHIELS (PHD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:SHIELS
Last Name:ROSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1806
Mailing Address - Country:US
Mailing Address - Phone:716-474-9813
Mailing Address - Fax:
Practice Address - Street 1:716 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1806
Practice Address - Country:US
Practice Address - Phone:716-474-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist