Provider Demographics
NPI:1972951440
Name:ROSEDALE PRIMARY CARE PHYSICIAN, P.C.
Entity type:Organization
Organization Name:ROSEDALE PRIMARY CARE PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOFEI
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-218-5523
Mailing Address - Street 1:540 MONTCLAIR CT
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9801
Mailing Address - Country:US
Mailing Address - Phone:410-218-5523
Mailing Address - Fax:
Practice Address - Street 1:19 FONTANA LN
Practice Address - Street 2:SUITE 108-110
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3047
Practice Address - Country:US
Practice Address - Phone:410-218-5523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty