Provider Demographics
NPI:1649268889
Name:ROST, DEBORAH B (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:B
Last Name:ROST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:J
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14836 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:DARNESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3622
Mailing Address - Country:US
Mailing Address - Phone:301-963-2595
Mailing Address - Fax:
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-330-0661
Practice Address - Fax:301-977-6940
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO051889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82928Medicare UPIN