Provider Demographics
NPI:1275981441
Name:DE LA ROSA, MANUEL CARLOS JR (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:CARLOS
Last Name:DE LA ROSA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-8480
Practice Address - Fax:410-614-8156
Is Sole Proprietor?:No
Enumeration Date:2016-05-28
Last Update Date:2024-10-01
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Provider Licenses
StateLicense IDTaxonomies
MA279506207R00000X
MDD0095205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine