Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 82332 | MD |
NPI | 1447866074 |
---|---|
Provider Name | Rosetta Randolph |
First Address | Baltimore, MD 21209-4832 |
Second Address | Baltimore, MD 21209-4832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2020 |
Last Update Date | 18/09/2020 |