Provider Demographics
NPI:1457351348
Name:ROSE, JACQUELINE EVA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:EVA
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5675 HARPERS FARM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2268
Mailing Address - Country:US
Mailing Address - Phone:410-964-5423
Mailing Address - Fax:410-964-4332
Practice Address - Street 1:5675 HARPERS FARM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2268
Practice Address - Country:US
Practice Address - Phone:410-964-5423
Practice Address - Fax:410-964-4332
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039059207L00000X
DCMD30640207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine