Provider Demographics
NPI:1285383174
Name:MOBLEY, ROTUNDA
Entity type:Individual
Prefix:
First Name:ROTUNDA
Middle Name:
Last Name:MOBLEY
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 1:3909 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1211
Mailing Address - Country:US
Mailing Address - Phone:301-683-8542
Mailing Address - Fax:
Practice Address - Street 1:5900 PRINCESS GARDEN PKWY STE 705
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2925
Practice Address - Country:US
Practice Address - Phone:301-683-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD032623064OtherDUNN AND BRADSTREET