Provider Demographics
NPI:1528335429
Name:ROSEU MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:ROSEU MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UZOCHUKWU
Authorized Official - Middle Name:WILFRED
Authorized Official - Last Name:UNEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-604-8000
Mailing Address - Street 1:7350 VAN DUSEN RD STE 390
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5231
Mailing Address - Country:US
Mailing Address - Phone:301-604-8000
Mailing Address - Fax:301-604-4406
Practice Address - Street 1:7350 VAN DUSEN RD STE 390
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5231
Practice Address - Country:US
Practice Address - Phone:301-604-8000
Practice Address - Fax:301-604-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71264261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036057160Medicaid
MD036057160Medicaid