Provider Demographics
NPI:1720794795
Name:ROTACARE MARYLAND INC.
Entity type:Organization
Organization Name:ROTACARE MARYLAND INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO/ DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-880-3202
Mailing Address - Street 1:3202 TOWER OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4219
Mailing Address - Country:US
Mailing Address - Phone:888-880-3202
Mailing Address - Fax:
Practice Address - Street 1:3202 TOWER OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4219
Practice Address - Country:US
Practice Address - Phone:888-880-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty