Provider Demographics
NPI:1700656063
Name:RIDORE, ROSENIE
Entity Type:Individual
Prefix:
First Name:ROSENIE
Middle Name:
Last Name:RIDORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10065 COTTON MILL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1340
Mailing Address - Country:US
Mailing Address - Phone:240-909-1395
Mailing Address - Fax:
Practice Address - Street 1:155 POTOMAC PSGE UNIT 617
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1573
Practice Address - Country:US
Practice Address - Phone:240-909-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDXXXXXX2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound